Optimal Postoperative Surveillance Strategies for Colorectal Cancer: A Retrospective Observational Study

SIMPLE SUMMARY: Optimal surveillance strategies for colorectal cancer remain undetermined, with intensive surveillance not conferring significant survival benefits. This study aimed to assess whether surveillance intensity is associated with recurrence and survival in patients with colorectal cancer. This retrospective observational study showed that, although frequent postoperative surveillance did not improve overall survival or recurrence-free survival, surveillance improved post-recurrence survival. Analysis using a recurrence risk-prediction model showed that intensive surveillance improved both post-recurrence survival and overall survival in patients who were at high risk of recurrence. Thus, intensive surveillance does not improve overall survival and recurrence-free survival but can help improve post-recurrence survival by detecting early-stage recurrence or increasing the curative resection rate. ABSTRACT: This study aimed to assess whether surveillance intensity is associated with recurrence and survival in colorectal cancer (CRC) patients. Overall, 3794 patients with pathologic stage I–III CRC who underwent radical surgery between January 2012 and December 2014 were examined. Surveillance comprised abdominopelvic computed tomography (CT) every 6 months and chest CT annually for 5 years. Patients who underwent more than and less than an average of three imaging examinations annually were assigned to the high-intensity (HI) and low-intensity (LI) groups, respectively. Demographics were similar in both groups. T and N stages were higher and perineural and lymphovascular invasion were more frequent in the HI group (p < 0.001 each). The mean overall survival (OS) was similar for both groups; however, recurrence-free survival (RFS) was longer (p < 0.001) and post-recurrence survival (PRS) was shorter (p = 0.024) in the LI group. In the multivariate analysis, surveillance intensity was associated with RFS (p < 0.001) in contrast to PRS (p = 0.731). In patients with high recurrence risk predicted using the nomogram, OS was longer in the HI group (p < 0.001). A higher imaging frequency in patients at high risk of recurrence could be expected to lead to a slight increase in PRS but does not improve OS. Therefore, rather than increasing the number of CT scans in high-risk patients, other imaging modalities or innovative approaches, such as liquid biopsy, are required.