Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Sep 27, 2021; 13(9): 1012-1024
Published online Sep 27, 2021. doi: 10.4240/wjgs.v13.i9.1012
Optimal postoperative surveillance strategies for stage III colorectal cancer
Min Young Park, In Ja Park, Hyo Seon Ryu, Jay Jung, Minsung Kim, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
Min Young Park, Colon and Rectal Surgery, Asan Medical Center, Seoul 05505, South Korea
In Ja Park, Hyo Seon Ryu, Jay Jung, Minsung Kim, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim, Colon and Rectal Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul 05505, South Korea
Author contributions: Kim JC, Yu CS, and Lim SB guaranted the integrity of the study; Park IJ conceptualized the study; Park IJ and Park MY collected the data, edited the manuscript; Park MY did statistical analysis and prepared manuscript; Park IJ, Park MY, Ryu HS, Jung J, and Kim MS reviewed manuscript; all authors have read and approve the final manuscript.
Institutional review board statement: This study was approved by the Institutional Review Board of Asan Medical Center, No: 2017-0955.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: In Ja Park, MD, PhD, Doctor, Professor, Surgeon, Colon and Rectal Surgery, Asan Medical Center and University of Ulsan College of Medicine, No. 88 Olympic-ro, Songpa-gu, Seoul 05505, South Korea. ipark@amc.seoul.kr
Received: February 24, 2021
Peer-review started: February 24, 2021
First decision: May 13, 2021
Revised: June 3, 2021
Accepted: August 2, 2021
Article in press: August 2, 2021
Published online: September 27, 2021
Abstract
BACKGROUND

Optimal surveillance strategies for stage III colorectal cancer (CRC) are lacking, and intensive surveillance has not conferred a significant survival benefit.

AIM

To examine the association between surveillance intensity and recurrence and survival rates in patients with stage III CRC.

METHODS

Data from patients with pathologic stage III CRC who underwent radical surgery between January 2005 and December 2012 at Asan Medical Center, Seoul, Korea were retrospectively reviewed. Surveillance consisted of abdominopelvic computed tomography (CT) every 6 mo and chest CT annually during the 5 year follow-up period, resulting in an average of three imaging studies per year. Patients who underwent more than the average number of imaging studies annually were categorized as high intensity (HI), and those with less than the average were categorized as low intensity (LI).

RESULTS

Among 1888 patients, 864 (45.8%) were in HI group. Age, sex, and location were not different between groups. HI group had more advanced T and N stage (P = 0.002, 0.010, each). Perineural invasion (PNI) was more identified in the HI group (21.4% vs 30.3%, P < 0.001). The mean overall survival (OS) and recurrence-free interval (RFI) was longer in the LI group (P < 0.001, each). Multivariate analysis indicated that surveillance intensity [odds ratio (OR) = 1.999; 95% confidence interval (CI): 1.680–2.377; P < 0.001], pathologic T stage (OR = 1.596; 95%CI: 1.197–2.127; P = 0.001), PNI (OR = 1.431; 95%CI: 1.192–1.719; P < 0.001), and circumferential resection margin (OR = 1.565; 95%CI: 1.083–2.262; P = 0.017) in rectal cancer were significantly associated with RFI. The mean post-recurrence survival (PRS) was longer in patients who received curative resection (P < 0.001). Curative resection rate of recurrence was not different between HI (29.3%) and LI (23.8%) groups (P = 0.160). PRS did not differ according to surveillance intensity (P = 0.802).

CONCLUSION

Frequent surveillance with CT scan do not improve OS in stage III CRC patients. We need to evaluate role of other surveillance method rather than frequent CT scans to detect recurrence for which curative treatment was possible because curative resection is the important to improve post-recurrence survival.

Keywords: Colorectal cancer, Surveillance intensity, Survival, Recurrence

Core Tip: This is a retrospective study to evaluate the association between surveillance intensity and recurrence and survival rates in patients with stage III colorectal cancer (CRC). The overall survival (OS) and recurrence-free interval (RFI) was longer in the low intensity group. Post-recurrence survival (PRS) did not change according to surveillance intensity. Therefore, frequent postoperative imaging studies do not improve OS or RFI in patients with stage III CRC. However, in high-risk patients, early detection of recurrence improves the chance of curative resection, which may improve PRS.