Intensive or not surveillance of patients with colorectal cancer after curative resection

It is common practice to follow patients with colorectal cancer for some years after resection and/or adjuvant treatment.Data are lacking about how often patients should be seen,what tests should be performed,and what surveillance strategy has a signifi cant impact on patient outcome.Seven randomized trials have addressed this issue,but none had sufficient statistical power.Four published meta-analyses have established that overall survival is significantly improved for patients in the more intensive programs of follow-up.This improvement amounts to a risk difference of 7%(95% CI:3%-12%,P=0.002) in 5-year survival.This should be partly attributable to more frequent reoperation for cure of asymptomatic recurrence,or more intense follow-up,as well other factors,such increased psychosocial support and well-being,diet and lifestyle optimization,and/or improved treatment of coincidental diseases.A large-scale multicenter European study [Gruppo Italiano di Lavoro per la Diagnosi Anticipata(GILDA)] is underway to answer the question of what constitutes optimal surveillance for patients after primary therapy,based on an adequately powered study.