Diagnostic yield of follow-up in patients undergoing surgery for non-metastatic colorectal cancer

Table 1 Population and primary colorectal cancer characteristics (n = 574), n (%)

Parameters	Value
Age, years, mean ± SD	70.1 ± 11.36
Sex
Male	347 (60.5)
Female	227 (39.5)
TNM stage
I	125 (21.8)
II	227 (39.5)
III	222 (38.7)
Location
Right colon	153 (26.7)
Transverse colon	35 (6.1)
Left colon	226 (39.4)
Rectum	160 (27.8)
Type of surgery
Right hemicolectomy	165 (28.8)
Left hemicolectomy/sigmoidectomy	204 (35.6)
Anterior rectal resection	140 (24.4)
Abdomino-peritoneal amputation	26 (4.5)
Other	39 (6.8)
Laparoscopic surgery
Yes	133 (23.2)
No	441 (76.8)
Pre-operative complications
Intestinal perforation	22 (3.8)
Intestinal occlusion	48 (8.4)
Postoperative complications
Suture dehiscence	87 (15.2)
Paralytic ileus	28 (4.9)
Eventration	14 (2.4)
Intra-abdominal infection	20 (3.5)
Other	42 (7.3)
Adjuvant chemotherapy
Yes	207 (36.1)
No	367 (63.9)
Neoadjuvant radio-chemotherapy
Yes	71 (12.4)
No	503 (87.6)

Table 2 Analysis of metastases/recurrences detected at follow-up

	Liver	Lung	Peritoneal	Anastomotic recurrence	Metachronous CRC	Other	Several locations	Total
CT diagnostic
CT 1	34	16	6	7	3	3	13	86
CT 2	8	10	4	4	1	5	7	42
CT 3	2	3	0	2	1	2	5	15
CT 4	0	4	0	0	0	2	2	8
CT 5	0	1	0	0	0	1	0	2
Total	44	34	10	13	5	13	27	146
Median detection time (months)	12 (8.8-15.2)	22 (16.3-27.7)	13 (6.8-19.2)	20 (16.8-23.2)		32 (13.2-50.8)	26 (16.6-21.4)
Colonoscopy diagnosis
Colonoscopy 1				7	3
Colonoscopy 2				4	0
Colonoscopy 3				0	3
Total				11	6
Median detection time (months)				22 (18-39.5)
TMs elevation
Yes	37	14	6	16		7	21
No	5	20	4	9		5	5
% Yes (P = 0.01)	88.1	41.2	60.0	64.0		58.3	80.8

CT: Computed tomography; CRC: Colorectal cancer; TMs: Tumor markers.

Table 3 Factors associated with adherence to recommendations for the first follow-up colonoscopy and computed tomography scan, n (%)

		The 1st surveillance colonoscopy		P value	Multivariate analysis OR (95%CI)	P value	CT 1		P value	Multivariate analysis OR (95%CI)	P value
		Yes	No				Yes	No
Average age (Number of patients)		66.97 (394)	76.69 (131)	< 0.001	0.91 (0.89-0.94)	< 0.001	68.7 (483)	76.6 (56)	< 0.001	1.06 (1.03-1.10)	< 0.001
Sex	Male	245 (76.6)	75 (23.4)	0.32			299 (91.2)	29 (8.8)	0.14
	Female	149 (72.7)	56 (27.3)				184 (87.2)	27 (12.8)
TNM stage	I-II	248 (77.3)	71 (22.3)	0.05	1		298 (90.0)	33 (10.0)	0.69
	III	141 (70.1)	60 (29.9)		2.47 (1.46-4.18)	< 0.001	185 (88.9)	23 (11.1)
Location	Right colon	119 (73.0)	44 (27.0)	0.47			146 (85.9)	24 (14.1)	0.05	1
	Left colon	275 (76.0)	87 (24.0)				337 (91.3)	32 (8.7)		0.80 (0.44-0.15)	0.46
Surgery	Laparoscopy	111 (87.4)	16 (12.6)	< 0.001	1		122 (94.6)	7 (5.4)	0.03	1
	Laparotomy	283 (71.1)	115 (28.9)		2.59 (1.43-4.78)	0.002	361 (88.0)	49 (12.0)		2.03 (0.87-4.71)	0.10
Perioperative complications	Yes	42 (65.6)	22 (34.4)	0.06	1		59 (90.8)	6 (9.2)	0.68
	No	352 (76.4)	109 (23.6)		0.99 (0.52-1.88)	0.98	424 (89.5)	50 (10.5)
Postoperative complications	Yes	130 (68.8)	59 (31.2)	0.01	1		173 (89.2)	21 (10.8)	0.46
	No	264 (78.6)	72 (21.4)		0.76 (0.48-1.20)	0.24	310 (89.9)	35 (10.1)
Adjuvant chemotherapy	Yes	173 (84.8)	31 (15.2)	< 0.001	2.11 (1.18-3.78)	0.01	197 (96.1)	8 (3.9)	< 0.001	2.46 (1.09-5.54)	0.03
	No	221 (68.8)	100 (31.2)		1		286 (85.6)	48 (14.4)		1
Neoadjuvant radio-chemotherapy	Yes	63 (91.3)	6 (8.7)	< 0.001	2.18 (0.87-5.50)	0.01	69 (97.2)	2 (2.8)	0.03	2.29 (0.51-10.16)	0.28
	No	331 (72.6)	125 (27.4)		1		414 (88.5)	54 (11.5)		1

CT: Computed tomography; OR: Odds ratio; TNM: Tumor-node-metastasis.

Table 4 Risk factors for death at 5-year follow-up, n (%)

	All-cause mortality		P value	Multivariate analysis, OR (95%CI)	P value	CCR mortality		P value	Multivariate analysis, OR (95%CI)	P value
	Yes	No				Yes	No
Sex
Male	144 (41.5)	203 (58.5)	0.9			61 (17.6)	286 (82.4)	0.7
Female	93 (41.0)	134 (59.0)				37 (16.3)	190 (83.7)
Average age	75.3	66.3	< 0.001	0.93 (0.91-0.95)	< 0.001	71.5	66.3	< 0.001	0.97 (0.94-0.99)	0.05
TNM stage
I-II	125 (35.4)	228 (64.6)	< 0.001	0.38 (0.24-0.61)	< 0.001	34 (9.6)	319 (90.4)	< 0.001	0.26 (0.15-0.46)	< 0.001
III	112 (50.7)	109 (49.3)		1		64 (29.0)	157 (71.0)		1
Location
Right hemicolon	84 (44.7)	104 (55.3)	0.25			29 (15.4)	159 (84.6)	0.46
Left hemicolon	153 (39.6)	233 (60.4)				69 (17.9)	317 (82.1)
Surgery
Laparoscopy	42 (31.6)	91 (68.4)	0.01	0.72 (0.44-1.17)	0.19	17 (12.8)	116 (87.2)	0.13	0.68 (0.36-1.27)	0.22
Laparotomy	195 (44.2)	246 (55.8)		1		81 (18.4)	360 (81.6)		1
Perioperative complications
Yes	36 (51.4)	34 (48.6)	0.07	1.14 (0.62-2.09)	0.68	20 (28.6)	50 (71.4)	0.01	1.72 (0.91-3.27)	0.1
No	201 (39.9)	303 (60.1)		1		78 (15.5)	426 (84.5)		1
Postoperative complications
Yes	113 (51.6)	106 (48.4)	< 0.001	1.41 (0.93-2.14)	0.1	42 (19.2)	117 (80.8)	0.29	1.25 (0.72-2.04)	0.37
No	124 (34.9)	231 (65.1)		1		56 (15.8)	299 (84.2)		1
Adjuvant chemotherapy
Yes	71 (34.3)	136 (65.7)	0.01	1.04 (0.64-1.74)	0.84	50 (26.9)	136 (73.1)	0.06	1.60 (0.95-2.72)	0.08
No	166 (45.2)	201 (54.8)		1		48 (19.3)	201 (80.7)		1
Neoadjuvant chemo-radiotherapy
Yes	21 (29.6)	50 (70.4)	0.03	1.14 (0.61-2.31)	0.69	12 (19.4)	50 (80.6)	0.518
No	216 (42.9)	287 (57.1)		1		86 (23.1)	287 (76.9)
Adherence to follow-up recommendations
Yes	62 (21.6)	225 (78.4)	< 0.001	0.30 (0.20-0.46)	< 0.001	32 (12.5)	225 (87.5)	< 0.001	0.35 (0.21-0.59)	< 0.001
No	141 (55.7)	112 (44.3)		1		65 (36.7)	112 (63.3)		1

CT: Computed tomography; OR: Odds ratio; TNM: Tumor-node-metastasis; CCR: Colorectal cancer.