Postsurgical follow-up of patients with colorectal cancer. Experience of five years

Background: We do have several algorithms for surveillance of patients who have had resection for a colorectal cancer (CC) but it is still not clear how often and by what means patients should be evaluated. Follow-up protocols do not make differences concerning the localisation of a large bowel cancer.

Aim: To evaluate colonoscopic findings after different type of large bowel cancer resections.

Patients and Methods: At Uzsoki Hospital, Budapest 508 colonoscopies were performed after CC surgery from January 1997 until December 2001. The following subgroups were examined: patients with right sided hemicolectomy/HD/(n=113), left sided hemicolectomy/HS/(n=190), resection of the rectum/RR/(n=98), exstirpation of the rectum/RE/(n=107).

Results: Polyps, cancer or stenosis were found in 30% of HD, 43.7% of HS, 49% of RR and 30% of RE patients. There was no significant difference concerning polyps (27.4–34.7%). The (significantly) highest rate of recurrent CC was after RR (11.2%). From 66.7% to 100% of recurrent CC and from 71.8% to 88% of polyps were found in the first three years after surgery in HD, HS, and RR patients. But 100% of recurrent cancer and 70% of polyps were found in RE patients after more than three years after large bowel resection.

Conclusions: Patients who are candidates for RR need more strict rules before surgery and for the follow-up period, too. It is advised to follow up RE patients for more than 5 years, perhaps even life-long. Patients with HD, HS and RR should be carefully followed in the postoperative three years, but later on the usefulness and cost effectiveness of colonoscopy might be questioned.