Camuñas J, Enriquez J M, Devesa J M, Morales V, Millan I
Universidad de Alcalá de Henares, Hospital Ramón y Cajal, Department of General Surgery, Madrid, Spain.
Eur J Surg Oncol. 1991 Oct;17(5):530-5.
The purpose of this article was to study the effectiveness of a prospective follow-up programme in patients after curative surgery for colorectal cancer. Of the initial 151 selected patients, 61 (40%) developed a recurrence in whom only six cases (10%) of potentially curable recurrent lesions were detected. The first clues to recurrence in the 61 patients were history or physical examination in 49%, a rising CEA in 29% and a positive imaging finding in 10%, being difficult to decide which test first signalled a recurrent cancer in an additional 11%. Endoscopy and CEA determinations were the most rewarding investigations. CEA was a sensitive means of identifying disseminated recurrent disease and liver metastases compared with liver function tests or liver ultrasound every 3 months. Endoscopy was useful in the diagnosis of local recurrences. However no follow-up test was capable of detecting recurrent colorectal cancer when it might still have been curable. As a direct result of this follow-up programme 15 patients (23%) underwent re-exploration. No symptomatic patients were candidates for curative re-operation. Of the asymptomatic patients six (four colonic and two rectal cancers) (19.5%) were re-resected for cure. Only three of these were alive and without evidence of disease, 40, 43 and 69 months later so that long term survivors after curative re-resection represent only 5% of all patients with recurrences (7.2% of the recurrent colonic cancer and 3% of the rectal cancer). Our follow-up programme did not permit us to alter the incidence of disseminated recurrent disease, and the effectiveness of the curative re-resection represents an increase of only 1.3% in the global 5-year survival rates for colorectal cancer. Our study does not demonstrate any great value of 'classical' postoperative follow-up programme.
本文旨在研究一项前瞻性随访计划对接受结直肠癌根治性手术后患者的有效性。在最初选定的151例患者中，61例（40%）出现复发，其中仅检测到6例（10%）可能治愈的复发病变。61例复发患者中，复发的最初线索有：49%通过病史或体格检查发现，29%通过癌胚抗原（CEA）升高发现，10%通过影像学检查阳性发现，另有11%难以确定哪种检查最先提示复发性癌症。内镜检查和CEA测定是最有价值的检查。与每3个月进行的肝功能检查或肝脏超声检查相比，CEA是识别播散性复发性疾病和肝转移的敏感方法。内镜检查对局部复发的诊断有用。然而，没有任何随访检查能够在复发性结直肠癌仍有可能治愈时检测到它。作为该随访计划的直接结果，15例患者（23%）接受了再次探查。没有有症状的患者适合进行根治性再次手术。在无症状患者中，6例（4例结肠癌和2例直肠癌）（19.5%）接受了根治性再次切除。其中只有3例在40、43和69个月后存活且无疾病证据，因此根治性再次切除后的长期存活者仅占所有复发患者的5%（结肠癌复发患者的7.2%和直肠癌复发患者的3%）。我们的随访计划未能使我们改变播散性复发性疾病的发生率，根治性再次切除的有效性仅使结直肠癌的全球5年生存率提高了1.3%。我们的研究未显示“经典”术后随访计划有任何重大价值。
