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Disease groups
Guidelines for follow up after resection of colorectal cancer
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  1. J H Scholefield1,
  2. R J Steele2
  1. 1Department of Surgery, University Hospital, Nottingham, UK
  2. 2Department of Surgery, Ninewells Hospital, Dundee, UK
  1. Correspondence to:
    Professor J H Scholefield, Department of Surgery, University Hospital, Nottingham NG7 2UH, UK;
    john.scholefield{at}nottingham.ac.uk

https://doi.org/10.1136/gut.51.suppl_5.v3

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    Follow up after colorectal resection is a surgical tradition, which has become a routine part of clinical practice consuming considerable amounts of scarce resources and for which there is precious little evidence of benefit to the patient.

    Colorectal cancer is a common condition and is the third most common cancer in the UK. The main treatment for this disease is surgical excision. Each consultant colorectal surgeon sees an average of 50 new patients with colorectal cancer each year and probably sees them in an outpatient clinic between one and four times per year. The cost of this type of follow up is uncertain but a recent survey in the United States showed the cost of five years’ follow up varied from $900 to $27 000 per patient.1 As there are over 30 000 new cases of colorectal cancer per annum in England and Wales the use of NHS resources for this group of patients alone is likely to run into tens of millions of pounds per annum.

    EXECUTIVE SUMMARY

    1. Although there is no evidence that intensive follow up for the detection of recurrent disease improves survival, it is reasonable to offer liver imaging to asymptomatic patients under the age of 70 in order to detect operable liver metastases once during the first two years after resection. (Recommendation Grade:A)

    2. Although there is no evidence that colonoscopic follow up improves survival, it does produce a yield of treatable tumours. It is recommended that a “clean” colon is examined by colonoscopy five years after surgery and thereafter at five yearly intervals up to the age of 70 years. (Recommendation Grade:B)

    3. In the absence of randomised trials, the only realistic argument for routine follow up is patient support and audit. Audit should be focused on outcome measures.

    PREVALENCE AND INCIDENCE

    There are approximately 30 000 new cases of …

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