In people who had resection for colon cancer, intensive monitoring does not increase survival

Mokhles S, Macbeth F, Farewell V, et al. Meta-analysis of colorectal cancer follow-up after potentially curative resection. Br J Surg. 2016;103:1259-68.

Review question

In people who have potentially curative resection (removal of part of the colon) for colon cancer, does intensive monitoring increase survival?

Background

Some people who have colon cancer have the diseased part of the colon removed in hopes of curing the cancer. However, sometimes the cancer comes back, so people are occasionally checked for signs and symptoms. It seems logical that checking more frequently or with new methods might allow earlier detection and therefore more effective treatment of recurrence.

How the review was done

The researchers did a systematic review, searching for studies available until 2016.

They found 16 randomized controlled trials with 9,993 people. 7 of these trials (3,325 people) provided survival data and were at low risk for bias, and were included in the assessment of survival.

People in the trials had colon cancer that had been treated with resection.

Intensive follow-up assessments included blood tests, endoscopy or colonoscopy, or pictures (computerized tomography scan, liver ultrasound, or chest x-ray). Follow-up could be led by a surgeon or a general practitioner; and follow-up assessments could occur more frequently than normal.

Intensive follow-up was compared with the usual tests and frequencies of follow-up.

What the researchers found

Cancer recurrence was detected about 10 months sooner in patients who had intensive follow-up compared with patients who had usual follow-up.

However, patients did not survive any longer when they had:

• any more intensive follow-up compared with any less intensive follow-up;
• endoscopy added to their usual follow-up; or
• follow-up in a hospital or specialist setting compared with in a general practice setting.

Conclusion

In people who had potentially curative resection for colon cancer, intensive monitoring does not increase survival.

Effect of intensive follow-up vs usual follow-up on survival in patients who had resection for colon cancer