Johnson Frank E, Longo Walter E, Ode Kenichi, Shariff Umar S, Papettas Trifonas, McGarry Alaine E, Gammon Steven R, Lee Paul A, Audisio Riccardo A, Grossmann Erik M, Virgo Katherine S
Department of Surgery, Saint Louis University, St. Louis, MO 63110, USA.
Int J Oncol. 2005 Sep;27(3):815-22.
The follow-up of patients with rectal cancer after potentially curative resection has significant financial and clinical implications for patients and society. The ideal regimen for monitoring patients is unknown. We evaluated the self-reported practice patterns of a large, diverse group of experts. There is little information available describing the actual practice of clinicians who perform potentially curative surgery on rectal cancer patients and follow them after recovery. The 1795 members of the American Society of Colon and Rectal Surgeons were asked, via a detailed questionnaire, how often they request 14 discrete follow-up modalities in their patients treated for cure with TNM stage I, II, or III rectal cancer over the first five post-treatment years. 566/1782 (32%) responded and 347 of the respondents (61%) provided evaluable data. Members of the American Society of Colon and Rectal Surgeons typically follow their own patients postoperatively rather than sending them back to their referral source. Office visit and serum CEA level are the most frequently requested items for each of the first five postoperative years. Endoscopy and imaging tests are also used regularly. Considerable variation exists among these highly experienced, highly credentialed experts. The surveillance strategies reported here rely most heavily on relatively simple and inexpensive tests. Endoscopy is employed frequently; imaging tests are employed less often. The observed variation in the intensity of postoperative monitoring is of concern.
直肠癌患者在进行潜在根治性切除术后的随访，对患者和社会具有重大的经济和临床意义。目前尚不清楚监测患者的理想方案。我们评估了一大群背景各异的专家自我报告的实践模式。关于对直肠癌患者进行潜在根治性手术并在其康复后进行随访的临床医生的实际做法，现有信息很少。通过一份详细问卷，我们询问了美国结直肠外科医师协会的1795名成员，在治疗后的头五年里，他们对TNM分期为I、II或III期的直肠癌根治性治疗患者，要求进行14种不同随访方式的频率。1782名成员中有566名（32%）回复，其中347名受访者（61%）提供了可评估数据。美国结直肠外科医师协会的成员通常在术后自行随访患者，而不是将他们转回转诊机构。在术后的头五年里，门诊就诊和血清癌胚抗原（CEA）水平是最常要求检查的项目。内镜检查和影像学检查也经常使用。在这些经验丰富、资质良好的专家中存在相当大的差异。此处报告的监测策略主要依赖相对简单且廉价的检查。内镜检查经常使用；影像学检查使用较少。术后监测强度的观察到的差异令人担忧。
