Early surveillance after surgery

This study evaluated the value of early surveillance using computed tomography (CT) after surgery to remove stage II or III colorectal cancer.

Treatment of colorectal cancer involves resection surgery, in which the tumor is removed along with neighboring parts of the colon or rectum. However, over half of the patients who undergo resection experience recurrence (return) of the cancer. Recurrence of colorectal cancer often appears in other organs (known as metastatic recurrence), specifically in the liver or the lungs. Once metastatic recurrence occurs, surgical removal of the new tumors is considered the optimal treatment. However, by the time recurrence is detected, surgery is often no longer possible. Indeed, research has shown that early diagnosis of recurrence is crucial for patient survival.

Currently, surveillance to detect cancer recurrence most commonly involves blood tests and CT scans preformed once a year, for 3 to 5 years following surgery. A CT scan is an imaging technique, based on X-rays, which generates a highly detailed picture of the body. This study evaluated whether early surveillance, by CT scans performed only 6 months following surgery, shows any additional benefit in stage II or III colorectal cancer.

150 patients treated with surgery for stage II or III colorectal cancer were included in this study. 46% of patients had stage II cancer (no lymph nodes involvement) and 64% of patients had stage III cancer (cancer that has spread to nearby lymph nodes). All patients received a surveillance CT scan within 6 months of surgery.

Cancer recurrence was discovered in only 10 (6.7%) patients by the early surveillance CT scan 6 month after surgery. Early recurrence was significantly more common among stage III patients, and directly related to the extent of lymph node involvement. However, only 3 of the patients were able to undergo additional surgery to remove the new tumor. The 3 patients able to receive surgery showed an average survival of 30 months following recurrence. Normally, the survival of metastatic recurrence patients without treatment is estimated to be around 10 months.

This study concluded that the use of early surveillance with CT scans 6 months after surgery may be beneficial in increasing the survival of some patients. However, early surveillance should only be considered for patients at a high risk for recurrence.

This study involved a relatively small number of patients, and not all patients were followed at regular intervals using the same scanning technique. The results of this study should be confirmed in a larger group of patients.

Consult with your physician regarding the optimal recurrence surveillance plan suited for your individual recurrence risk.