Role of surveillance imaging and endoscopy in colorectal cancer follow-up:Quality over quantity?

摘要

Colorectal cancer(CRC) is a prevalent disease and represents a major cause of morbidity and mortality in the developed world. Intensive post-treatment surveillance is routinely recommended by major expert groups for early stage(Ⅱ and Ⅲ) CRC survivors because previous meta-analyses showed a modest, but significant survival benefit. This practice has been recently challenged based on data emerging from several large phase Ⅲ randomized trials that demonstrated a lack of survival benefit from intensive surveillance strategies. In addition,findings from cost-effectiveness analyses of such an approach are inconsistent.Data on real-world practice, specifically adherence to these follow-up guidelines,are also limited. The debate is especially controversial in resected stage Ⅳ patients where there are currently no clear guidelines for follow-up. In an era of personalized medicine, there may be a shift towards a more risk-adapted approach to better define the optimal follow-up strategy. In this article, we review the evidence and highlight the role of surveillance in CRC survivors.