IS IT NECESSARY TO FOLLOW-UP PATIENTS OPERATED ON FOR COLORECTAL-CANCER

Survival improvement in patients operated on for colorectal cancer mig ht be the consequence of early diagnosis, rather than improvement in t he treatment and follow-up. Therefore the question is:how to follow-up patients operated on for colorectal cancer ? And even: is it necessar y to follow-up these patients ? Follow-up has two intentions,to diagno se metachronous tumors (adenomas and cancers), and to reveal a relapsi ng disease. However more than a relapse, diagnosis of a ''residual'' d isease is questioned. This residual disease was present after what was thought to be a ''curative'' treatment, but lack of sensitivity of ou r diagnosis tools delayed the diagnosis. Follow-up is worthwhile if pr ognostic of patient treated of their ''residual'' disease is better wh en diagnosis is made during this follow-up, rather than when it is pos tponed until the disease become symptomatic. This has never been prove d. Exams which should not be performed anymore are : CA 19-9,liver rea ls, systematic CT scan (as a diagnosis exam, but CT scan is worthwhile when a curative treatment is expected), systematic repeted colonoscop y. Conclusions on follow-up proposed at a recent consensus conference reached consensus in that ii justified exams which effectiveness was n ever proved...