Postoperative follow-up for colorectal cancer: who are we kidding?

The results of treatment of colorectal cancer have improved little over the last 40 years. This reflects both the advanced age of the patients and the advanced stage of the disease at diagnosis. Currently, extensive multimodality, periodic evaluation of patients is advocated following potentially curative resections in the hope that colorectal cancer recurrence will be identified when metastases are isolated and curable. Such efforts, however, have failed to make any substantial impact on survival. At this time, the identification of colorectal cancer at an earlier than usual stage appears to be the only means by which survival can be improved. Despite this, substantially more effort and resources are devoted to the postoperative follow-up of patients with colorectal cancer than to the identification of early curable colorectal cancer. In the current economic climate and with limited medical resources, it may be more appropriate to aim primarily at identifying early curable lesions by more routine colonscopy.