Krishnan A, Mukherjee D. Challenges in colorectal cancer post-surgical surveillance: A critical evaluation and path forward. World J Gastrointest Surg 2025; 17(6): 106965 [DOI: 10.4240/wjgs.v17.i6.106965]
Corresponding Author of This Article
Arunkumar Krishnan, MD, Department of Supportive Oncology, Atrium Health Levine Cancer, 1021 Morehead Medical Drive, Suite 70100, Charlotte, NC 28204, United States. dr.arunkumar.krishnan@gmail.com
Research Domain of This Article
Oncology
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Jun 27, 2025; 17(6): 106965 Published online Jun 27, 2025. doi: 10.4240/wjgs.v17.i6.106965
Challenges in colorectal cancer post-surgical surveillance: A critical evaluation and path forward
Arunkumar Krishnan, Diptasree Mukherjee
Arunkumar Krishnan, Department of Supportive Oncology, Atrium Health Levine Cancer, Charlotte, NC 28204, United States
Diptasree Mukherjee, Department of Medicine, Apex Institute of Medical Science, Kolkata 700075, West Bengal, India
Author contributions: Krishnan A contributed to the concept of the study, drafted the manuscript, and participated in the review and editing; Krishnan A and Mukherjee D were involved with critically revising the manuscript for important intellectual content; they contributed equally to this article, and all authors reviewed and approved the final version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Arunkumar Krishnan, MD, Department of Supportive Oncology, Atrium Health Levine Cancer, 1021 Morehead Medical Drive, Suite 70100, Charlotte, NC 28204, United States. dr.arunkumar.krishnan@gmail.com
Received: March 12, 2025 Revised: April 10, 2025 Accepted: May 7, 2025 Published online: June 27, 2025 Processing time: 79 Days and 23.1 Hours
Abstract
A recent study by Sala-Miquel et al investigated the diagnostic effectiveness of follow-up strategies in patients with non-metastatic colorectal cancer (CRC) after surgical resection. This research highlighted the significance of using computed tomography (CT), colonoscopy, and tumor markers for the early detection of recurrence or metastasis. The findings indicated that strict adherence to follow-up protocols can contribute to decreased mortality rates among these patients. However, the study has several limitations that must be considered. It was retrospective and conducted at a single center, which may affect the generalizability of the results. Further, the absence of a control group and the exclusion of stage IV patients limit the study's applicability. Methodological issues, including insufficient adjustment for confounding variables, a lack of sensitivity analyses, and limitations in time-dependent covariate analysis, further constrain the conclusions' robustness. Moreover, while the study emphasizes the role of CT scans, it does not adequately address their potential risks and underrepresents the importance of colonoscopy. Future research should focus on multicenter, prospective studies that integrate personalized follow-up approaches and explore innovative technologies to enhance the efficacy of follow-up strategies in CRC management. By addressing these limitations, researchers can improve the applicability and impact of follow-up strategies in the care of CRC patients.
Core Tip: The study by Sala-Miquel et al evaluated the diagnostic efficacy of follow-up strategies, including computed tomography, colonoscopy, and tumor markers, in detecting recurrences or metastases after surgery for non-metastatic colorectal cancer (CRC). At the same time, the study highlighted the importance of these tools in optimizing post-surgical care; its retrospective, single-center design limits generalizability. Future research should adopt multicenter, prospective designs and include control groups to reduce bias and improve applicability. Addressing confounders like comorbidities and socioeconomic factors, alongside sensitivity analyses, would improve statistical robustness. Integrating emerging technologies such as circulating tumor DNA and patient-centered approaches can enhance diagnostic accuracy and adherence, ultimately refining CRC surveillance outcomes.
