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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Diagnostic yield of follow-up in patients undergoing surgery for non-metastatic colorectal cancer
Noelia Sala-Miquel, José Carrasco-Muñoz, Soledad Bernabeu-Mira, Carolina Mangas-Sanjuan, Sandra Baile-Maxía, Lucía Madero-Velázquez, Victor Ausina, Ana Yuste, Lucía Gómez-González, Manuel Romero Simó, Pedro Zapater, Rodrigo Jover
Noelia Sala-Miquel, José Carrasco-Muñoz, Soledad Bernabeu-Mira, Carolina Mangas-Sanjuan, Sandra Baile-Maxía, Lucía Madero-Velázquez, Victor Ausina, Department of Gastroenterology, Hospital General Universitario Dr. Balmis, Alicante 03010, Valencia, Spain
Ana Yuste, Lucía Gómez-González, Department of Oncology, Hospital General Universitario Dr. Balmis, Alicante 03010, Valencia, Spain
Manuel Romero Simó, Department of Surgery, Hospital General Universitario Dr. Balmis, Alicante 03010, Valencia, Spain
Pedro Zapater, Clinical Pharmacology Unit, Hospital General Universitario Dr. Balmis, Alicante 03010, Valencia, Spain
Rodrigo Jover, Department of Gastroenterology, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante 03010, Valencia, Spain
Author contributions: Jover R and Sala-Miquel N designed the study and acquired funding; Sala-Miquel N, Carrasco-Muñoz J and Bernabeu-Mira S were responsible for data collection and compilation; Jover R, Sala-Miquel N and Zapater P were responsible for analysis and interpretation of the data; Jover R and Sala-Miquel N wrote the original draft; Jover R, Sala-Miquel N, Mangas-Sanjuan C, Baile-Maxía S, Zapater P, Yuste A, Romero Simó M, Gómez-González L, Madero-Velázquez L and Ausina V participated in the review, editing and final approval of the article.
Supported by Instituto de Investigación Sanitaria ISABIAL, No. P42022-0275.
Institutional review board statement: Hospital General Universitario Dr. Balmis of Alicante Institutional Review Board approval was obtained in June 2023 (No. PI2020-154).
Informed consent statement: As this was a retrospective study, the ethics committee did not consider it necessary to obtain informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Rodrigo Jover, MD, PhD, Professor, Department of Gastroenterology, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research Instituto de Investigación Sanitaria y Biomédica de Alicante, Pintor Baeza Avenue, 12, Alicante 03010, Valencia, Spain.
rodrigojover@gmail.com
Received: August 8, 2024
Revised: November 26, 2024
Accepted: February 26, 2025
Published online: March 28, 2025
Processing time: 229 Days and 23.4 Hours
BACKGROUND
Evidence on adherence, diagnostic performance and impact on survival to intensive follow-up after surgery for colorectal cancer (CRC) is limited.
AIM
To analyze the diagnostic performance of surveillance colonoscopy, computed tomography (CT), and tumor markers (TMs) in detecting CRC recurrence or metastasis during follow-up after CRC resection. Secondary objectives included degree of adherence to clinical practice guidelines surveillance recommendations and factors associated with adherence and all-cause and CRC mortality.
METHODS
The single-center retrospective cohort study including patients undergoing curative resection of stage I-III CRC during 2010-2015. Follow-up was performed using TMs every 6 months, yearly CT for 5 years, and colonoscopy at years 1 and 4. Demographic, primary tumor data, and results at follow-up were collected.
RESULTS
Of 574 included patients included, 153 had recurrences or metastases. Of this group, 136 (88.9%) were diagnosed by CT, 10 (6.5%) by CT and colonoscopy, and 7 (4.6%) by colonoscopy; only 67.8% showed TMs elevation. Adherence to follow-up recommendations was 68.8% for the first colonoscopy, 74% for the first CT scan, and 96.6% for the first blood test; these values declined over time. Younger age at diagnosis [odds ratio (OR) 0.93; 95%CI: 0.91-0.95], CRC stages I-II (OR 0.38; 95%CI: 0.24-0.61), and adherence to follow-up recommendations (OR 0.30; 95%CI: 0.20-0.46) were independently associated with lower risk for all-cause death at 5 years.
CONCLUSION
CT scan had the highest diagnostic yield. Adherence to follow-up recommendations was low and decreased during follow-up. Younger age at diagnosis, stage, and follow-up adherence were associated with lower 5-year mortality.
Core Tip: Post-surgical follow-up of colorectal cancer allows detection of local and distant recurrences. The incidence of metastasis or recurrence within the first 3-5 years after surgery is high. However, evidence on diagnostic yield of computed tomography (CT), colonoscopy and tumour markers (TMs) and impact on survival is limited. CT scan is associated with the highest yield for metastasis and recurrence detection. If follow-up is performed with blood test TMs only, an important proportion of recurrences would be missed. Compliance with intensive follow-up is an independent protective factor against mortality.
