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

Table 1 Summary of postoperative surveillance recommendations for colorectal cancer by different professional societies

Organization	History/physical	CEA	CT scan	Endoscopy
ASCO 2013[14] (stage II-III)	Every 3-6 mo for 5 yr	Every 3-6 mo for 5 yr	Chest/abdomen +/-pelvis (if rectal) annually for 3-5 yr	Colonoscopy at 1 yr; if negative, every 5 yr. Rectal cancer: proctosigmoidoscopy every 6 mo for 2-5 yr if no pelvic RT
ESMO colon 2013[15] (Stage I, II, III)	Every 3-6 mo for 3 yr, then every 6-12 mo for 2 yr	Every 3-6 mo for 3 yr, then every 6-12 mo for 2 yr	Chest and abdomen every 6-12 mo for 3 yr; transabdominal ultrasound can be used instead of CT abdomen	Colonoscopy at 1 yr; of negative, every 3-5 yr subsequently.
ESMO rectal 2013[16] (Stage II, III)	Every 6 mo for 2 yr	Every 6 mo for 3 yr	At least 2 chest/abdomen/pelvis in the first 3 yr	Colonoscopy every 5 yr up to age 75
NCCN 2018[17] (Stage II, III, resected IV)	Every 3-6 mo for 2 yr, then every 6 mo for 3 yr	Every 3 to 6 mo for 2 yr for ≥ T2 disease, then every 6 mo for 3 yr (up to 5 if resected metastatic)	Colon: Chest/abdomen/ pelvis every 6-12 mo for up to 5 yr. For rectal cancer, CT chest/abdomen and pelvis every 3-6 mo for 2 yr, then every 6-12 mo for up to 5 yr	Colonoscopy at 1 yr; if negative, repeat at 3 yr, then every 5 yr subsequently. If adenoma found, repeat at 1 yr.
USMSTF 2016[7] (only for endoscopic surveillance)				Colonoscopy at 1 yr; if negative, repeat at 3 yr, then every 5 yr. For rectal cancer, flexible sigmoidoscopy or EUS every 3-6 mo for the first 2 to 3 yr after surgery for patients at high risk for local recurrence

CEA: Carcinoembryonic antigen; CT: Computed tomography; ASCO: American society of clinical oncology; ESMO: European society for medical oncology; NCCN: National comprehensive cancer network; USMSTF: United States Multi-Society Task Force.