Question: Should more tests vs fewer tests be used for non metastatic colorectal cancer follow up?

Quality assessmentSummary of findingsImportance
No of patientsEffectQuality
No of studiesDesignLimitationsInconsistencyIndirectnessImprecisionOther considerationsmore testsfewer tests(95% CI)
16.1%
more v less colonoscopy for overall survival (Wang 2009) (follow-up mean 5 years)
1randomised trialsSerious1no serious inconsistencyno serious indirectnessSerious2none42/165
(25.5%)
50/161
(31.1%)
HR 1.41 (0.92 to 2.14)⊕⊕○○
LOW
CRITICAL
31.1%
3.4%
more v less colonoscopy for recurrence (anastomotic and metachronous) Wang 2009 (follow-up mean 5 years)
1randomised trialsSerious1no serious inconsistencyno serious indirectnessSerious2none13/165
(7.9%)
18/161
(11.2%)
OR 1.35 (0.64–2.83)⊕⊕○○
LOW
CRITICAL
11.2%
more v less colonoscopy for anastomotic recurrence Wang 2009 (follow-up mean 5 years)
1randomised trialsSerious1no serious inconsistencyno serious indirectnessSerious2none10/13
(76.9%)
7/18 (38.9%)OR 5.24 (1.06 to 26)⊕⊕○○
LOW
CRITICAL
38.9%
more v less colonoscopy for curative surgery attempted for recurrence (Wang 2009) (follow-up mean 5)
1randomised trialsSerious1no serious inconsistencyno serious indirectnessSerious2none9/13 (69.2%)8/18 (44.4%)OR 0.12 (0.02 to 0.91)⊕⊕○○
LOW
CRITICAL
44.4%
1

there was no blinding in the study introducing high risk of performance and detection bias.

2

the total number of events is very low (less than 300 rule of thumb).

Bibliography

  • Wang T, Cui Y, Huang WS, Deng YH, Gong W, Li CJ, Wang JP. The role of postoperative colonoscopic surveillance after radical surgery for colorectal cancer: a prospective randomised clinical study. Gastrointestinal endoscopy. 2009;69(3):609–615. [PubMed: 19136105]

References

  • Jeffery M, Hickey BE, Hider PN. Follow-up strategies for patients treated for non-metastatic colorectal cancer. Cochrane Database of Systematic Reviews. 2007;2007(1) [PubMed: 17253476]
  • Tjandra JJ, Chan MKY. Follow-up after curative resection of colorectal cancer: a meta-analysis. Diseases Colon & Rectum. 2007;50(11):1783–1799. [PubMed: 17874269]
  • Wang T, Cui Y, Huang WS, Deng YH, Gong W, Li CJ, Wang JP. The role of postoperative colonoscopic surveillance after radical surgery for colorectal cancer: a prospective randomised clinical study. Gastrointestinal endoscopy. 2009;69(3):609–615. [PubMed: 19136105]
  • Laubert T, Bader FG, Oevermann E, Jungbluth T, Unger L, Roblick UJ, et al. Intensified surveillance after surgery for colorectal cancer significantly improves survival. Eur J Med Res. 2010;15(1):25–30. [PMC free article: PMC3351844] [PubMed: 20159668]
  • Kjeldsen BJ, Thorsen H, Whalley D, et al. A prospective randomised study of follow-up after radical surgery for colorectal cancer. The British Journal of Surgery. 1997;85(5):666–669. [PubMed: 9171758]
  • Wattchow DA, Weller DP, Esterman A, et al. General practice versus surgical based follow-up for patients with colon cancer: randomised controlled trial. British Journal of Cancer. 2006;94(8):1116–1121. [PMC free article: PMC2361245] [PubMed: 16622437]

From: 5, Ongoing Care and Support

Cover of Colorectal Cancer
Colorectal Cancer: The Diagnosis and Management of Colorectal Cancer.
NICE Clinical Guidelines, No. 131.
National Collaborating Centre for Cancer (UK).
Copyright © 2011, National Collaborating Centre for Cancer.

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