Follow-up after curative resection of colorectal cancer: a meta-analysis

Dis Colon Rectum. 2007 Nov;50(11):1783-99. doi: 10.1007/s10350-007-9030-5.


Purpose: This is a systematic review to evaluate the impact of various follow-up intensities and strategies on the outcome of patients after curative surgery for colorectal cancer.

Methods: All randomized trials up to January 2007, comparing different follow-up intensities and strategies, were retrieved. Meta-analysis was performed by using the Forest plot review.

Results: Eight randomized, clinical trials with 2,923 patients with colorectal cancer undergoing curative resection were reviewed. There was a significant reduction in overall mortality in patients having intensive follow-up (intensive vs. less intensive follow-up: 21.8 vs. 25.7 percent; P = 0.01). Regular surveillance with serum carcinoembryonic antigen (P = 0.0002) and colonoscopy (P = 0.04) demonstrated a significant impact on overall mortality. However, cancer-related mortality did not show any significant difference. There was no significant difference in all-site recurrence and in local or distant metastasis. Detection of isolated local and hepatic recurrences was similar. Intensive follow-up detected asymptomatic recurrence more frequently (18.9 vs. 6.3 percent; P < 0.00001) and 5.91 months earlier than less intensive follow-up protocol; these were demonstrated with all investigation strategies used. Intensive surveillance program detected recurrences that were significantly more amenable to surgical reresection (10.7 vs. 5.7 percent; P = 0.0002). The chance of curative reresection were significantly better with more intensive follow-up (24.3 vs. 9.9 percent; P = 0.0001), independent of the investigation strategies used.

Conclusions: Intensive follow-up after curative resection of colorectal cancer improved overall survival and reresection rate for recurrent disease. However, the cancer-related mortality was not improved and the survival benefit was not related to earlier detection and treatment of recurrent disease.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Carcinoembryonic Antigen / blood
  • Colonoscopy
  • Colorectal Neoplasms / mortality*
  • Colorectal Neoplasms / surgery*
  • Continuity of Patient Care*
  • Humans
  • Neoplasm Recurrence, Local / diagnosis
  • Neoplasm Recurrence, Local / surgery
  • Outcome and Process Assessment, Health Care*
  • Quality of Life
  • Randomized Controlled Trials as Topic
  • Reoperation
  • Survival Analysis


  • Carcinoembryonic Antigen