Prolonged follow-up of colorectal cancer patients after 5 years: to follow or not to follow, that is the question (and how)!

Abstract

It is estimated that in 2018 there were 1.8 million patients diagnosed with colorectal cancer (CRC) worldwide resulting in 862,000 deaths, which is an increase from 2012 by 33% and 24%, respectively (1). Surgical resection remains the standard of care for resectable, non-metastatic, CRC. Following complete resection, more than 90% of recurrences occur in the first 5 years with most occurring in the first 3 years (2). Beyond 5 years, however, there are currently no clear recommendations. There are some studies with up to 10 years of follow-up after surgery that have reported late recurrences after 5 years (3), thus the utility of prolonged follow-up after the initial 5 years is an important question. To address this knowledge gap, Kong et al. investigated the efficacy of prolonged follow-up beyond 5 years using a retrospective cohort of 1,054 CRC patients who underwent radical resection from 1980 to 1996 at their institution (4). The patient cohort consisted of 15% rightsided colon tumors, 18% left-sided colon tumors, and 62% rectal tumors. Pathological stages included 14% stage I, 56% stage II, and 31% stage III. Patients were followed every 3 months for the first 2 years, every 6 months in the following 3 years, and then yearly. To detect local or distant recurrence, the authors utilized a physical exam, ultrasound, X-ray, and computed tomography. The authors found significant associations between survival and the following variables: age (P=0.026), tumor site (P<0.001), and pathologic stage (P<0.001). Compared to patients who died within 5 years of surgery, patients who survived past 15 years had a higher Caso et al. Follow-up of CRC patients after 5 years

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