Sensitivity versus cost effectiveness in postoperative follow-up for colorectal cancer

The incidence of colorectal cancer is increasing. Approximately 20% of patients present with untreatable, disseminated disease. The remaining 80% are generally treated by intended curative resection. Unfortunately, about 40% of the Dukes B2 and C patients will develop recurrent disease. Of these patients, about one third will develop hepatic metastases, one fifth pulmonary metastases, one fifth intra-abdominal metastases, one tenth retroperitoneal metastases, and one twentieth anastomotic recurrences. Rectal cancer patients may have pelvic recurrence rates as high as one third. Unfortunately, only about one fifth of the Dukes B2 and C patients will initially develop recurrences at only one site and are, thus, potentially curable. Indeed, when considering all colorectal cancer patients, resectable recurrences will be detected in the liver in only 2%, regional recurrences in about 10%, in the lungs in 2%, anastomotic recurrences in less than 1%, and in the ovaries in 1%. In general, long-term survival can be achieved in about 30% of these patients with salvage surgery. The goal of intensive follow-up programs has been to identify these sole site recurrences at an earlier, asymptomatic stage and thereby improve survival. Unfortunately this laudable goal has not been achieved. Intensive (and expensive) follow-up programs consistently achieve long-term survival in 0% to 4% of patients. Reliance on symptoms, however, achieves remarkably similar end results.(ABSTRACT TRUNCATED AT 250 WORDS)