Table 1.
Randomized controlled trials: Different surveillance strategies following curative colorectal cancer resection
|
Ref.
|
Surveillance strategy
|
No. of patients randomized
|
Significant benefit
|
| Ohlsson et al[44], 1995 | Total | 107 | No |
| None (FOBT) | 54 | ||
| Intensive follow-up: examinations, FOBT, CEA, endoscopy, CXR, CT | 53 | ||
| Mäkelä et al[37], 1995 | Total | 106 | No |
| Standard | 54 | ||
| More intensive examinations, FOBT, CEA, colonoscopy, CXR, liver US, CT | 52 | ||
| Kjeldsen et al[16], 1997 | Total | 597 | No |
| Standard | 307 | ||
| More intensive examinations, blood tests, FOBT, CXR, colonoscopy | 290 | ||
| Schoemaker et al[38], 1998 | Total | 325 | No |
| Standard: examinations, blood test, CEA, FOBT | 158 | ||
| Intensive: standard plus CXR, CT, colonoscopy | 167 | ||
| Pietra et al[57], 1998 | Total | 207 | Yes (increased curative reoperation; increased survival) |
| Standard | 103 | ||
| More intensive examinations, CEA, colonoscopy, CXR, liver US, CT | 104 | ||
| Secco et al[48], 2002 | Total | 358 (21 drop out) | Yes (increased curative reoperation; increased survival) |
| Minimal: examinations yearly and on demand | 145 | ||
| Risk-adapted | 192 | ||
| -Low risk: less frequent examinations, CEA, rectosigmoidoscopy, CXR, US | 84 | ||
| -High risk: more frequent examinations, CEA, rectosigmoidoscopy, CXR, US | 108 | ||
| Wattchow et al[58], 2006 | Different settings no different tests | 203 (46 lost fu) | No |
| General Practitioner | 81 | ||
| Surgeon visit | 76 | ||
| Rodríguez-Moranta et al[39], 2006 | Total | 259 | Yes (increased curative reoperation, increased survival only for stage II colon tumor and rectal tumor) |
| Standard: examinations, blood tests and CEA. Colonoscopy only if history of HNPCC and synchronous neoplasm | 127 | ||
| Intensive: standard plus annual colonoscopy, CXR, US and CT | 132 | ||
| Sobhani et al[59], 2008 | Total | 130 | Yes (increased curative reoperation; number of patients too small to evaluate survival) |
| Standard: examinations, CEA, CXR, US and CT | 65 | ||
| Intensive: standard plus 18FDG-PET | 65 | ||
| Wang et al[47], 2009 | Total | 326 | Yes (increased curative reoperation; no increased survival) |
| Standard: examinations, CEA, colonoscopy, CXR, liver US and CT | 161 | ||
| Intensive: standard plus more frequent colonoscopy | 165 | ||
| Strand et al[60], 2011 | Different settings no different tests | 110 | No |
| Nurse | 54 | ||
| Surgeon visit | 56 | ||
| Augestad et al[61], 2013 | Different settings no different tests | 110 | No |
| General Practitioner | 55 | ||
| Surgeon visit | 55 | ||
| Primrose et al[34] (FACS), 2014 | Total | 1202 | No |
| Minimal follow-up: no scheduled follow-up except a single CT scan at 12-18 mo | 301 | ||
| CEA follow-up: CEA every 3 mo for 2 yr, then every 6 mo for 3 yr, with a single CT scan at 12-18 mo | 300 | ||
| CT follow-up: CT scan every 6 mo for 2 yr, then annually for 3 yr | 299 | ||
| CEA and CT follow-up: combined CEA and CT imaging as above | 302 | ||
| Treasure et al[62] (the CEA Second-Look trial), 2014 | Total | Tot 216 | No |
| Standard: CEA monitoring with no further action even in case of CEA rising | 108 | ||
| Aggressive: CEA monitoring followed by second-look operation and possible resection in case of CEA rising | 108 | ||
| Verberne et al[35] (CEAwatch)1, 2015 | Total | 3223 | Yes (increased curative reoperation; no increased survival) |
| Standard: CEA every 3 mo, examinations, liver US and CXR every 6 mo | 1182 | ||
| Intensive: CEA every 2 mo, examinations and CT annually. If CEA rise, repeat CEA after 1 mo. If two consecutive CEA rise, CT scan | 316 | ||
| Standard and Intensive: patients participated both in the standard protocol and in the intensive protocol | 1725 | ||
| Rosati et al[49] (GILDA), 2016 | Total | 1228 | No |
| Standard: examinations, CEA, colonoscopy, CXR, liver imaging (US or CT scan) | 613 | ||
| Intensive: standard plus CA19-9, blood test, more frequent colonoscopy, CXR and liver imaging (US or CT), CT abdomen-pelvis | 615 | ||
| Wille-Jørgensen et al[63] (COLOFOL), 2018 | Total | 2509 | No |
| Standard: CEA, CT chest, abdomen and pelvis at 12 and 36 mo | 1256 | ||
| Intensive: CEA, CT chest, abdomen and pelvis every 6 mo for 2 yr, then at 36 mo | 1253 |
1
During the study period, hospitals changed from a standard follow-up schedule to the intensive follow-up schedule every 3 months. CEA: Carcinoembryonic antigen; CT: Computed tomography; CXR: Conventional chest radiography; FOBT: Fecal occult blood test; HNPCC: Hereditary non-polyposis colorectal cancer; mo: months; US: Ultrasonography; yr: years.