Follow-up after curative surgery for colorectal cancer

Approximately 1 in 3 colorectal patients treated by surgery with curative intent will develop cancer recurrence, and most of them will die from disseminated disease. Post-operative follow-up aims at improving these ominous figures. Any strategy is justified as far as it influences evolution: global survival, disease-free period, quality of life. The value of follow-up for patients remains controversial. The literature review suggests that more intensive follow-ups lead to an increased number of reoperations, a more aggressive oncological approach in non resectable cases, provide data for an efficient quality control and have a major cost impact. Surveillance is appreciated by the patients who are confident in the efficacy of such policies. On the other hand, the benefit on the outcome of the patients is not formally established. Outcome might depend on tumoural characteristics rather than on the moment of recurrence detection. Not all schedules are alike, and CEA determination is required. Including all patients in intensive programs is not evidence-based medicine and is highly cost ineffective. Follow-ups must be tailored to individual characteristics. The most intensive ones are dedicated to the patients with the highest risk of treatable recurrence: high risk patients (tumour site and stage), able and willing to undergo reoperation (age, general condition,...). Research should try to determine curability tumoural factors (genetic tumour factors). In the meantime, and for the other patients, the most effective follow-ups could be programs in which only a few tests are routinely used: referential colonoscopy, history and physical examination, CEA determination and a rectoscopy for rectal cancers.