Intensive follow-up strategies after radical surgery for nonmetastatic colorectal cancer: A systematic review and meta-analysis of randomized controlled trials

Abstract

Background: Intensive follow-up after surgery for colorectal cancers is common in clinical practice, but evidence of a survival benefit is limited.

Objective: To conduct a systematic review and meta-analysis on the effects of follow-up strategies for nonmetastatic colorectal cancer.

Data sources: We searched Medline, Embase, and CENTRAL databases through May 30, 2018.

Study selection: We included randomized clinical trials evaluating intensive follow-up versus less follow-up in patients with nonmetastatic colorectal cancer.

Interventions: Intensive follow-up.

Main outcomes measures: Overall survival.

Results: The analyses included 17 trials with a total of 8039 patients. Compared with less follow-up, intensive follow-up significantly improved overall survival in patients with nonmetastatic colorectal cancer after radical surgery (HR 0.85, 95% CI 0.74-0.97, P = 0.01; I2 = 30%; high quality). Subgroup analyses showed that differences between intensive-frequency and intensive-test follow-up (P = 0.04) and between short interval and long interval of follow-up (P = 0.02) in favor of the former one.

Limitations: Clinical heterogeneity of interventions.

Conclusions: For patients with nonmetastatic colorectal cancer after curative resection, intensive follow-up strategy was associated with an improvement in overall survival compared with less follow-up strategy. Intensive-frequency follow-up strategy was associated with a greater reduction in mortality compared with intensive-test follow-up strategy.

Fig 1. Flow diagram of the literature search.

Fig 2. Forest plot of overall survival of all trials.

df = degrees of freedom, M-H = Mantel-Haenszel.

Fig 3. Funnel plot analysis of overall survival.