Can J Gastroenterol Hepatol. 2014 Sep;28(8):427-33. doi: 10.1155/2014/870968. Epub 2014 Jul 11.
Postoperative surveillance following curative-intent resection of colorectal cancer (CRC) is variably performed due to existing guideline differences and to the limited data supporting different strategies.
To examine population-based rates of surveillance imaging and endoscopy in patients in Ontario following curative-intent resection of CRC with no evidence of recurrence, as well as patient or disease factors that may predispose certain groups to more frequent versus less frequent surveillance; to provide insight to the care patients receive in the presence of conflicting guidelines, in efforts to help improve care of CRC survivors by identifying any potential underuse or overuse of particular surveillance modalities, or inequalities in access to surveillance.
A retrospective cohort study was conducted using data from the Ontario Cancer Registry and several linked databases. Ontario patients undergoing curative-intent CRC resection from 2003 to 2007 were identified, excluding patients with probable disease relapse. In the five-year period following surgery, the number of imaging and endoscopic examinations was determined.
There were 4960 patients included in the study. Over the five-year postoperative period, the highest proportion of patients who underwent postoperative surveillance received the following number of tests for each modality examined: one to three abdominopelvic computed tomography (CT) scans (n=2073 [41.8%]); one to three abdominal ultrasounds (n=2443 [49.3%]); no chest CTs, one to three chest x-rays (n=2385 [48.1%]); and two endoscopies (n=1845 [37.2%]). Odds of not receiving any abdominopelvic imaging (CT or abdominal ultrasound) were higher in those who did not receive adjuvant chemotherapy (OR 6.99 [95% CI 5.26 to 9.35]) or those living in certain geographical areas, but were independent of age, sex and income. Nearly all patients (n=4473 [90.2%]) underwent ≥1 endoscopy at some point during the follow-up period.
In contrast to findings from similar studies in other jurisdictions, most Ontario CRC survivors receive postoperative surveillance with imaging and endoscopy, and care is equitable across sociodemographic groups, although unexplained geographical variation in practice exists and warrants further investigation.
由于现有指南的差异以及支持不同策略的数据有限，行结直肠癌（CRC）根治性切除术的患者术后随访的方式存在差异。
本研究旨在调查安大略省根治性切除 CRC 且无复发证据的患者术后进行影像学和内镜检查的人群率，以及可能导致某些人群接受更频繁或更不频繁监测的患者或疾病因素；为存在冲突指南的情况下患者所接受的治疗提供一些见解，旨在通过识别特定监测方式的潜在过度或不足使用或监测机会的不平等，帮助改善 CRC 幸存者的护理。
使用来自安大略癌症登记处和几个相关数据库的数据，进行了一项回顾性队列研究。研究纳入了 2003 年至 2007 年期间行根治性 CRC 切除术的患者，排除了可能发生疾病复发的患者。术后 5 年内，确定了影像学和内镜检查的数量。
研究纳入了 4960 例患者。在术后 5 年期间，接受术后监测的患者接受了以下每种检查的测试数量：1-3 次腹部盆腔 CT（n=2073 [41.8%]）；1-3 次腹部超声（n=2443 [49.3%]）；无胸部 CT，1-3 次胸部 X 射线（n=2385 [48.1%]）；2 次内镜检查（n=1845 [37.2%]）。未接受辅助化疗（OR 6.99 [95%CI 5.26 至 9.35]）或居住在某些地理区域的患者，其不接受任何腹部盆腔影像学（CT 或腹部超声）的可能性更高，但与年龄、性别和收入无关。在随访期间，几乎所有患者（n=4473 [90.2%]）都至少进行过 1 次内镜检查。
与其他司法管辖区的类似研究结果相比，安大略省大多数 CRC 幸存者接受影像学和内镜检查的术后随访，并且护理在社会人口统计学群体中是公平的，尽管实践中存在无法解释的地理差异，需要进一步调查。
