Long-term Follow-up of Patients with Curatively Resected Colorectal Cancer; May Long-term Follow-up of More than 5 Years be Warranted?

Moon, Sun Mi; Park, Jae Woo; Hwang, Dae Yong

Abstract

PURPOSE: The data and the recommendations for the postoperative follow-up period after curative surgery for colorectal cancer are unclear, although postoperative follow-up for at least 5 years is generally recommended. The Department of Surgery, Korea Cancer Center Hospital, has a policy of lifetime follow-up. The aim of this study is to investigate the long-term outcome of patients with colorectal cancer with curative treatment and the significance of long-term follow-up.
METHODS
Between January 1993 and December 2002, 1,100 consecutive patients underwent curative surgery for a colorectal adenocarcinoma in the Department of Surgery, Korea Cancer Center Hospital. They were followed, and local or systemic recurrence was recorded. The analysis was performed on 962 of the 1,100 (87%) patients who had undergone curative surgery.
RESULTS
With a median follow-up of 143 months, the 10-year overall survival (OS) was 67% and the 10-year recurrence-free survival (RFS) was 72%. The 5-year OS was 78%, and the 5-year RFS was 78%. Two hundred ninety-nine (31.5%) patients had recurrences. Of the recurrences, 278 (93.0%) became evident within 5 years and 21 (7.0%) presented after 5 years. Twenty-four (2.5%) patients had local recurrences alone, 17 had (1.8%) local plus systemic recurrences, and 258 (26.8%) had systemic recurrences alone. Of the local recurrences, 33 (80%) became evident within 5 years, and 8 (20%) presented after 5 years. Of the systemic recurrences, 258 (94%) became evident within 5 years and 17 (6%) presented after 5 years.
CONCLUSIONS
The long-term surveillance of patients undergoing a curative resection for colorectal cancer demonstrates that most local recurrences and distant metastases occur within 5 years after a 5-year follow-up, most local and systemic recurrences following curative surgery had occurred. However, our data suggest that the postoperative follow-up of more than 5 years may be warranted. Large, multicenter trials are required to define the patterns of disease recurrence after 5 years of follow-up.