Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 7, 2019; 25(1): 59-68
Published online Jan 7, 2019. doi: 10.3748/wjg.v25.i1.59
Role of surveillance imaging and endoscopy in colorectal cancer follow-up: Quality over quantity?
Shiru L Liu, Winson Y Cheung
Shiru L Liu, Department of Medical Oncology, University of British Columbia, Vancouver, BC V5Z 4E6, Canada
Winson Y Cheung, Department of Oncology, University of Calgary, Calgary, Alberta T2N 4N2, Canada
Author contributions: Liu SL and Cheung WY performed literature search and review, drafted the majority of the writing, prepared the figures and tables; Cheung WY provided editing and input for the paper.
Conflict-of-interest statement: The authors do not have any financial conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Winson Y Cheung, MD, Doctor, Department of Oncology, University of Calgary, 1331 29 St. NW, Calgary, Alberta T2N 4N2, Canada.
Telephone: +1-403-5213565 Fax: +1-403-9442331
Received: October 2, 2018
Peer-review started: October 2, 2018
First decision: October 26, 2018
Revised: November 25, 2018
Accepted: December 6, 2018
Article in press: December 6, 2018
Published online: January 7, 2019

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.

Keywords: Surveillance, Imaging, Endoscopy, Colorectal cancer, Follow-up

Core tip: Although several reviews in the literature have analyzed the different surveillance strategies for colorectal cancer, this is the most updated review that includes the current state of surveillance approaches with endoscopy and imaging, the most recently completed clinical trials and meta-analysis that failed to demonstrate survival benefit from traditional intensive surveillance strategies recommended by professional guidelines, real-world data, and recommendations for special populations.