How Frequently Is Colorectal Cancer Recurrence Detected in Clinic?

Abstract

Background: Outpatient clinic follow-up has been standard practice for decades following resection of colorectal cancer, however recent evidence regarding its efficacy in oncological detection is limited. With increasing health limitations and rising numbers of colorectal cancer patients, the role of clinic follow-up may need re-evaluation.

Objective: The aim of this study is to determine the frequency of clinical examination compared to other modalities in identification of colorectal cancer recurrence in Northland.

Design: Retrospective review of detection modalities for recurrence in colorectal cancer.

Setting: Northland region of New Zealand between January 2013 and December 2022.

Patients: Stage I - IV who underwent curative-intent surgery for colorectal adenocarcinoma.

Main outcome measures: The primary outcome was frequency of the initial mode of recurrence detection (computed tomography, carcinoembryonic antigen, colonoscopy, clinical examination and other modalities). Secondary outcomes were frequency of symptomatic presentation, detecting clinician, site, timing, and survival compared by mode of detection.

Results: From 747 patients with a median follow-up of 4.3 years, 157 (21.0%) had recurrence. The most frequent mode of detection was computed tomography (n = 85, 54%), followed by carcinoembryonic antigen (n = 43, 27%), colonoscopy (n = 9, 6%), other modalities (n = 16, 10%) and clinical examination (n = 4, 3%). There were 45 (29%) symptomatic presentations. Two examination recurrences were detected by the general practitioner and two at outpatient clinic, with three out of four being symptomatic. Recurrence detected by colonoscopy had significantly better 5-year overall survival (77.8%, p = 0.022) than computed tomography (30.9%) or carcinoembryonic antigen (38.3%), but most colonoscopy-detected recurrences were locoregional.

Conclusions: Outpatient clinic examination in identifying recurrence, particularly asymptomatic, made up only a very small proportion of recurrence detection methods. Given the minimal oncological benefit, alternative resource-saving strategies for clinic follow-up need consideration. See Video Abstract.