Goldberg R M, Fleming T R, Tangen C M, Moertel C G, Macdonald J S, Haller D G, Laurie J A
Mayo Clinic, Rochester, Minnesota 55905, USA.
Ann Intern Med. 1998 Jul 1;129(1):27-35. doi: 10.7326/0003-4819-129-1-199807010-00007.
Follow-up testing after surgery for colon cancer is recommended principally to identify resectable recurrences, but data on the efficacy of, outcomes of, and optimal strategies for this testing are limited.
To determine the relation between follow-up tests and salvage surgery, assess outcomes, and document surgical mortality.
Retrospective cohort study.
A North American multi-institutional trial comparing postoperative chemotherapy plus follow-up with follow-up alone.
1247 patients with resected stage II and stage III colon cancer.
The protocol mandated follow-up testing that could be supplemented at the discretion of treating physicians. Indications of recurrent disease were documented.
Recurrence, resectable recurrence, surgical mortality, and survival were studied.
548 patients had recurrence of colon cancer. Salvage surgery was attempted in 222 patients (41%). In 109 patients (20%), curative-intent surgery was done for hepatic recurrence (28 patients), pulmonary metastasis (20 patients), local recurrence (24 patients), or recurrence at other sites (37 patients). Most curative-intent surgical procedures were motivated by follow-up testing (36 patients), elevated carcinoembryonic antigen level (41 patients), or symptoms (27 patients). The median follow-up time after curative-intent surgery exceeded 5 years; the estimated 5-year disease-free survival rate was 23%. A solitary lesion was a favorable prognostic factor. The surgical mortality rate was 2%. Curative-intent resections were done in 15 patients with second primary colorectal cancer; 12 of these patients have survived disease-free.
Second operations for colon cancer that are triggered by follow-up testing or symptoms are common and can result in long-term disease-free survival.
结肠癌手术后的随访检测主要是为了发现可切除的复发灶，但关于这种检测的疗效、结果及最佳策略的数据有限。
确定随访检测与挽救性手术之间的关系，评估结果，并记录手术死亡率。
回顾性队列研究。
一项北美多机构试验，比较术后化疗加随访与单纯随访。
1247例接受切除的II期和III期结肠癌患者。
方案规定了随访检测，治疗医生可酌情补充。记录复发性疾病的指征。
研究复发、可切除复发、手术死亡率和生存率。
548例患者出现结肠癌复发。222例患者（41%）尝试了挽救性手术。109例患者（20%）因肝转移复发（28例）、肺转移（20例）、局部复发（24例）或其他部位复发（37例）接受了根治性手术。大多数根治性手术是由随访检测（36例）、癌胚抗原水平升高（41例）或症状（27例）引发的。根治性手术后的中位随访时间超过5年；估计5年无病生存率为２３％。孤立性病变是一个有利的预后因素。手术死亡率为2%。15例第二原发性结直肠癌患者接受了根治性切除；其中12例患者无病存活。
由随访检测或症状引发的结肠癌二次手术很常见，可导致长期无病生存。
