Vernava A M, Longo W E, Virgo K S, Coplin M A, Wade T P, Johnson F E
Department of Surgery, St. Louis University School of Medicine, Missouri 63110-0250.
Dis Colon Rectum. 1994 Jun;37(6):573-83. doi: 10.1007/BF02050993.
The follow-up of patients after potentially curative resection of colon cancer has important clinical and financial implications for patients and society, yet the ideal surveillance strategy is unknown.
The aim of this study was to determine the current follow-up practice pattern of a large, diverse group of experts.
The 1,663 members of The American Society of Colon and Rectal Surgeons were asked, via a detailed questionnaire, how often they request nine discrete follow-up evaluations in their patients treated for cure with TNM Stage I, II, or III colon cancer over the first five posttreatment years. These evaluations were clinic visit, complete blood count, liver function tests, serum carcinoembryonic antigen (CEA) level, chest x-ray, bone scan, computerized tomographic scan, colonoscopy, and sigmoidoscopy.
Forty-six percent (757/1663) completed the survey and 39 percent (646/1663) provided evaluable data. The results indicate that members of The American Society of Colon and Rectal Surgeons generally conduct follow-up on their patients personally after performing colon cancer surgery (rather than sending them back to their referral source). Routine clinic visits and CEA levels are the most frequently performed items for each of the five years. The large majority (> 75 percent) of surgeons see their patients every 3 to 6 months for years 1 and 2, then every 6 to 12 months for years 3, 4, and 5. Approximately 80 percent of respondents obtain CEA levels every 3 to 6 months for years 1, 2, and 3, and every 6 to 12 months for years 4 and 5. Colonoscopy is performed annually by 46 to 70 percent of respondents, depending on year. A chest x-ray is obtained yearly by 46 to 56 percent, depending on year. The majority of the members of The American Society of Colon and Rectal Surgeons do not routinely request computerized tomographic scan or bone scan at any time. There is great variation in the pattern of use of complete blood count and liver function tests. Members of The American Society of Colon and Rectal Surgeons from the United States tend to follow their patients more closely than do those living in other countries. The intensity of follow-up does not markedly vary across TNM Stages I to III.
The surveillance strategies reported here rely most heavily on clinic visits and CEA level determinations, generally reflecting guidelines previously proposed in the current literature.
对结肠癌进行潜在根治性切除术后的患者随访，对患者和社会具有重要的临床和经济意义，但理想的监测策略尚不清楚。
本研究旨在确定一大群不同专家目前的随访实践模式。
通过详细问卷，询问美国结肠和直肠外科医师协会的1663名成员，在其治疗的TNM I、II或III期结肠癌患者术后的头五年中，他们对九项不同随访评估的要求频率。这些评估包括门诊就诊、全血细胞计数、肝功能检查、血清癌胚抗原（CEA）水平、胸部X光、骨扫描、计算机断层扫描、结肠镜检查和乙状结肠镜检查。
46%（757/1663）完成了调查，39%（646/1663）提供了可评估数据。结果表明，美国结肠和直肠外科医师协会成员在进行结肠癌手术后，通常亲自对患者进行随访（而非将他们转回转诊机构）。常规门诊就诊和CEA水平是五年中每年最常进行的项目。绝大多数（>75%）外科医生在第1年和第2年每3至6个月看一次患者，然后在第3、4和5年每6至12个月看一次。约80%的受访者在第1、2和3年每3至6个月检测一次CEA水平，在第4和5年每6至12个月检测一次。46%至70%的受访者每年进行一次结肠镜检查，具体比例因年份而异。46%至56%的受访者每年进行一次胸部X光检查，具体比例因年份而异。美国结肠和直肠外科医师协会的大多数成员在任何时候都不常规要求进行计算机断层扫描或骨扫描。全血细胞计数和肝功能检查的使用模式差异很大。来自美国的美国结肠和直肠外科医师协会成员往往比其他国家的成员对患者随访更密切。随访强度在TNM I至III期之间没有明显差异。
此处报告的监测策略最主要依赖门诊就诊和CEA水平测定，总体上反映了当前文献中先前提出的指南。
