[Colorectal cancer surgery with curative intent: what surveillance?]

Colorectal cancer, incidence has increased by more than 50% over the past 30 years. On the other hand, over the same period, the number of deaths remained stable, which reflects major therapeutic progress. Around 75% of patients may benefit from surgical resection with curative intent. Among them, nearly 30% of stage II and more than 55% of stage III patients present a loco-regional or distant recurrence or a metachronous cancer within 5 years after initial treatment. This high risk of recurrence raises the question of postoperative monitoring in order to detect early recurrences and metachronous cancers at a curable stage. The annual incidence of adenomas is low and the cumulative risk of endoluminal recurrences or metachronous cancer is very low. Therefore intensive endoscopic monitoring is not useful. Postoperative monitoring of distant recurrences is poorly codified. However, despite their limits, recent trials and meta-analysis suggest that survival is increased thanks to clinical monitoring combined with hepatic and pulmonary imaging. CEA measurement usefulness remains debated. A large randomised trial of monitoring strategy ended recently and should provide answers. This report focused on the monitoring mode after curative resection.