Published online Jan 7, 2019. doi: 10.3748/wjg.v25.i1.59
Peer-review started: October 2, 2018
First decision: October 26, 2018
Revised: November 25, 2018
Accepted: December 6, 2018
Article in press: December 6, 2018
Published online: January 7, 2019
Colorectal cancer (CRC) is a prevalent disease and represents a major cause of morbidity and mortality in the developed world. Intensive post-treatment surveillance is routinely recommended by major expert groups for early stage (II and III) CRC survivors because previous meta-analyses showed a modest, but significant survival benefit. This practice has been recently challenged based on data emerging from several large phase III randomized trials that demonstrated a lack of survival benefit from intensive surveillance strategies. In addition, findings from cost-effectiveness analyses of such an approach are inconsistent. Data on real-world practice, specifically adherence to these follow-up guidelines, are also limited. The debate is especially controversial in resected stage IV patients where there are currently no clear guidelines for follow-up. In an era of personalized medicine, there may be a shift towards a more risk-adapted approach to better define the optimal follow-up strategy. In this article, we review the evidence and highlight the role of surveillance in CRC survivors.
Core tip: Although several reviews in the literature have analyzed the different surveillance strategies for colorectal cancer, this is the most updated review that includes the current state of surveillance approaches with endoscopy and imaging, the most recently completed clinical trials and meta-analysis that failed to demonstrate survival benefit from traditional intensive surveillance strategies recommended by professional guidelines, real-world data, and recommendations for special populations.