Intensive postoperation surveillance improves the survival of patients with stage II colorectal cancer

Systematic postoperative surveillance of patients with rectal and colorectal cancer has demonstrated to produce an improvement in the survival of these patients. Nevertheless, it is currently discussed whether a more intensive surveillance strategy would provide significant advantage compared to a less aggressive strategy. The methodology currently used for testing and the frequency tests are applied are highly heterogeneous. So, in order to compare the efficiency of two surveillance strategies, a standard strategy and an intensive strategy, physicians of Hospital Clínic conducted a prospective, multicentre and randomised study in patients affected by this type of cancer. This trial, supported by the Medical Technology Agency of the Catalan Government, was led by Dr. Francisco Rodríguez-Moranta and Dr. Antoni Castells, from the IDIBAPS Physiopathology of the Gastrointestinal Lesions Group, and had the collaboration of specialists of Hospital de Terrassa and Hospital General de Vic. The results of these comparison were published in Journal of Clinical Oncology (24(3):386-93), and showed that the most intensive therapy benefited patients in certain stages of cancer and patients with rectal lesions, whose overall survival was increased.

To conduct this study, 259 patients from the three centres with colorectal cancer in stage II or III (which are intermediate states in a scale ranging I-IV) were recruited and were randomly distributed in two surveillance experimental groups. In the first group, 132 patients received the simplest standard surveillance, consisting in the clinical evaluation and in the monitoring of blood tumour markers every three months. In the second group, the 127 patients were applied a strategy that, in addition to the standard, consisted in an abdominal CT-scan or ultrasonography, chest x-ray and colonoscopy. Both groups of patients were similar with respect to baseline characteristics as disease, tumour recurrence rate and type of tumour. After 48 months of follow-up, researchers did not detect significant difference in the overall survival between patients the of the two groups. However, as specific subgroups were analysed, the intensive strategy was associated to a higher survival, in number of years, in patients of stage II tumours and those with rectal lesions. Thus, this type of surveillance benefited this subtype of patients since relapse could be detected earlier. Particularly, colonoscopy was the method responsible for the detection of the highest proportion (44%) of recurrences of operable tumours.

According to the authors, this invasive strategy would improve the prognosis of patients with stage II colorectal cancer and also patients with rectal lesions. In this sense, they recommend the periodical colonoscopy during the first 5 years of postoperatory follow-up, a practice that is already applied in Hospital Clínic. The level of cost efficiency of this strategy is justified by the higher healing rate in case of relapse, since tumours are detected in their onset. Nevertheless, this strategy does not show more efficiency in other cases and it is important to continue to search for the most specific techniques for every case in order to avoid nonessential health expense. Although these results do not permit to define the perfect strategy for the follow-up of all patients with colorectal cancer, it permits to establish a strategy suitable for an important subgroup of patients (nearly half of patients suffering from this disease). The journal has written an editorial comment about the article in which both the study and the Catalan Government Support are acclaimed.