Meta-Analysis
Copyright ©The Author(s) 2023.
World J Gastrointest Oncol. Dec 15, 2023; 15(12): 2197-2211
Published online Dec 15, 2023. doi: 10.4251/wjgo.v15.i12.2197
Table 1 The baseline characteristics of included trials and recruited patients
Ref.
Region
Sample size
Age (yr)
Male (%)
Stage (A/B/C)
Tumor location (C/R)
Treatments
Intervention
Control
Follow-up duration
Mäkelä et al[23], 1995Finland10666.049.1(A/B/C) 28/48/3075/31Radical resection denotes surgical removal of all macroscopic tumor tissue with microscopically evaluated clearance of the surgical marginsFlexible sigmoidoscopy with video imaging every 3 mo, colonoscopy at 3 mo, then annually. They also had ultrasound of the liver and primary site at 6 mo, then annuallyRigid sigmoidoscopy
and barium enema annually
5.0 yr
Ohlsson et al[24], 1995Sweden10765.647.7(A/B/C) 19/47/4171/36Resection with curative intent and early postoperative colonoscopyPerformed at each visit were clinical exam, rigid proctosigmoidoscopy, CEA, alkaline phosphatase, gamma-glutaryl transferase, faecal haemoglobin, and CXR. Examination of anastomosis was performed at 9, 21, and 42 mo. Colonoscopy was performed at 3, 15, 30, and 60 mo. CT of the pelvis was performed at 3, 6, 12, 18, and 24 moWritten instructions recommending that they leave faecal samples with the district nurse for examination every 3 mo during the first 2 yr then once a year. They contact the surgical department if they had any symptoms5.5-8.8 yr
Kjeldsen et al[25], 1997Denmark597< 76.054.6(A/B/C) 138/293/166314/283Radical primary surgery and no residual neoplasia was detected by complete colonoscopy or incomplete colonoscopy plus double-contrast barium enema, chest radiograph, histological examination of all resection margins in surgical specimens, biopsy of lesions, and inspection and palpation of the liver during surgeryExaminations at 6, 12, 18, 30, 36, 48, 60, 120, 150, and 180 mo after radical surgery (medical history, clinical examination, digital rectal examination, gynaecological examination, Haemoccult-II test, colonoscopy, CXR, haemoglobin level, erythrocyte sedimentation rate, and liver enzymes)Examinations at 60, 120, and 180 mo (medical history, clinical examination, digital rectal examination, gynaecological examination, Haemoccult-II test, colonoscopy, CXR, haemoglobin level, erythrocyte sedimentation rate, and liver enzymes)5.0-10.0 yr
Pietra et al[26], 1998Italy20763.353.6(A/B/C) 0/122/85139/68Curative resection defined as one in which no macroscopic tumor remained at the end of the operation and in which histopathologic examination of the operative specimen showed no tumor at the lines of resectionExaminations at 3, 6, 9, 12, 15, 18, 21, 24, 30, 36, 42, 48, 54, and 60 mo, then annually thereafter. There was clinical examination, ultrasound, CEA, and CXR at each visit. Annual CT of the liver and colonoscopy were performedExaminations at 6 and 12 mo, then annually. At each visit, clinical examination, CEA, and ultrasound were performed. They had annual CXR, yearly colonoscopy, and CT scan5.0 yr
Schoemaker et al[27], 1998Australia32568.063.7(A/B/C) 71/153/101238/87Curative resectionYearly CXR, CT of the liver, and colonoscopyClinical grounds or after screening test abnormality, and at 5 yr of follow-up, to exclude a reservoir of undetected recurrences5.0 yr
Secco et al[28], 2002Italy33765.148.4(A or B/C) 201/136NAPutative curative surgery alone, which defined as macriscopic excision of the primary tumour, peritumoral tissues and palpable locoregional lymph nodesClinic visits and serum CEA, abdomen/pelvic US scans, and CXR. Participants with rectal carcinoma had rigid sigmoidoscopy and CXRMinimal follow-up programme performed by physicians4.0-5.1 yr
Rodríguez-Moranta et al[29], 2006Spain25968.062.2(II/III) 157/102194/65Curative resection, complete colon study was achieved with colonoscopy to determine the presence of synchronous lesions. If colonoscopy of the entire bowel could not be performed before resection, a postoperative colonoscopy was warrantedSeen with history, examination, and bloods (including CEA) at 3, 6, 9, 12, 15, 18, 21, 24, 27, 30, 33, 36, 39, 42, 45, 48, 51, 54, 57, and 60 mo; US/CT at 6, 12, 18, 24, 30, 36, 42, 48, and 56 mo; CXR and colonoscopy at 12, 24, 36, 48, and 56 moSeen with history, examination, and bloods (including CEA) at 3, 6, 9, 12, 15, 18, 21, 24, 27, 30, 33, 36, 39, 42, 45, 48, 51, 54, 57, and 60 mo4.0 yr
Wattchow et al[30], 2006Australia203NA53.6(A/B/C) 47/96/60203/0Curative surgery and completion of postsurgical chemotherapyEvery 3 mo for the first 2 yr postoperatively, then every 6 mo for the next 3 yrAsking a list of set questions about symptoms, physical examination, annual faecal occult blood testing, and colonoscopy every 3 yr2.0 yr
Sobhani et al[31], 2008France13060.1NAIV: 1775/55Curative surgery, compliance with adjuvant chemotherapy, and the absence of disease progression and/or missed synchronous metastases were checkedPET performed at 9 and 15 mo and conventional follow-upConventional follow-up2.0 yr
Wang et al[32], 2009China32654.554.3(A/B/C) 100/133/93171/155Curative surgery, which was defined as one in which no macroscopic tumor remained at the end of the operation and in which histopathologic examination of the operative specimen demonstrated no tumor at the margins of resectionColonoscopy at each visitColonoscopy at 6 mo, 30 mo, and 60 mo from randomisation5.3-6.5 yr
Strand et al[33], 2011Sweden11068.053.6(I/II/III/IV) 26/40/36/80/110Curative surgery, all patients had a first postoperative visit with the surgeon for information on histology and adjuvant therapy. Consecutive patients were asked to participate at various postoperative controls starting after the adjuvant chemotherapy was terminatedSurgeon-led follow-upNurse-led follow-up5.0 yr
Augestad et al[34], 2013Norway11065.459.1(A/B/C) 24/55/32110/0Surgery and received postsurgical adjuvant chemotherapySurgeon follow-upGP follow-up2.0 yr
Primrose et al[35], 2014United Kingdom120269.261.2(A/B/C) 254/553/354811/359Curative surgery, and adjuvant treatment if indicated, with no evidence of residual disease on investigationCEA testing every 3 mo for 2 yr, then every 6 mo for 3 yr with a single CT scan of the chest/abdomen/pelvis if requested at study entry by clinician; CT scan of the chest/ abdomen/pelvis every 6 mo for 2 yr, then annually for 3 yr, plus colonoscopy at 2 yr; CEA and CT follow-up: Both blood and imaging as above, plus colonoscopy at 2 yrNo scheduled follow-up except a single CT scan of the chest/ abdomen/pelvis if requested at study entry by a clinician3.4 yr
Treasure et al[36], 2014United Kingdom21663.059.3(A/B/C) 10/95/101NACurative resection for adenocarcinoma of the colon or rectum and who were fit and willing to adhere to the postoperative monitoring routineCEA rise triggered the “second-look” surgery, with intention to remove any recurrence discoveredConventional follow-up2.0 yr
Rosati et al[37], 2016Italy122863.960.7(B/C) 617/611933/295Curative intent, with adjuvant radio-chemotherapy if indicated4, 8, 12, 16, 20, 24, 30, 36, 42, 48, and 60 monthly office visits and history and clinical examination, FBC, CEA, and CA 19-9; colonoscopy and CXR at 12, 24, 36, 48, and 60 mo; liver US at 4, 8, 12, 16, 24, 36, 48, and 60 mo; for rectal participants, pelvic CT at 4, 12, 24, and 48 mo4, 8, 12, 16, 20, 24, 30, 42, 48, and 60 monthly office visits, including history, examination, and CEA; colonoscopy at 12 and 48 mo; liver US at 4 and 16 mo; rectal cancer participants in addition had rectoscopy at 4 mo, CXR at 12 mo, and liver US at 8 and 16 mo. A single pelvic CT was allowed if a radiation oncologist required it as baseline following adjuvant treatment5.2 yr
Wille-Jørgensen et al[38], 2018Denmark and Uruguay250964.955.0(II/III) 1352/1157884/1625Curative intent, with adjuvant treatment if indicated, a colon and rectum free of neoplasia verified by perioperative barium enema or a colonoscopy within 3 mo after surgeryMultislice contrast-enhanced CT of the thorax and abdomen and CEA at 6, 12, 18, 24, and 36 mo after surgeryMultislice contrast-enhanced CT of the thorax and abdomen and CEA at 12 and 36 mo after surgery3.0 yr
Rahr et al[39], 2019Denmark19670.063.8(I/II/III/IV) 47/66/49/16140/56Elective surgery for verified or suspected CRC were screened by a study nurse for cardiopulmonary comorbidity at the preoperative visitRoutine follow-up with one extra medical visit and additional visits to the Cardiology and Respiratory Medicine Clinics 1 and 3 mo postoperativelyRoutine follow-up1.0 yr
Monteil et al[40], 2021France36565.054.8(I/II/III/IV) 2/176/185/2290/75Curative surgery, with adjuvant treatment if indicatedPET/CT and conventional follow-up every 3 moCEA, liver echography, and alternated between lung radiography and CT scans3.0 yr