Cost and benefit of regular follow-up programs after resection of gastrointestinal malignancies

Aim of the study: To determine the costs and benefit of standardized follow-up programs after surgical therapy of gastrointestinal malignancies. Methods: Retrospective analysis of the results and the costs of regular outpatient follow-up examinations after radical resection of colorectal (n=552), gastric (n=180), and esophageal carcinoma (n=160). Results: The diagnostic efficiency of regular follow-up concerning the diagnosis of asymptomatic tumor recurrences was 9% in esophageal, 10% in gastric, and 15% in colorectal carcinoma. The average follow-up costs for each asymptomatic recurrence were about 10.000 DM. R0-resection of asymptomatic recurrences or metachronous tumors was performed in none of the patients with esophageal and gastric carcinomas and in 22 patients with colorectal carcinomas (4% of all patients with colorectal carcinomas). In contrast to the low therapeutic efficiency in tumor recurrences, the therapeutic efficiency with regard to the treatment of postoperative nonmalignant functional disorders was significantly higher (esophageal carcinoma: 63%, gastric carcinoma: 40%, colorectal carcinoma: 24% of the follow-up examinations). Conclusions: In order to examine, whether the cost-benefit-relation of regular follow-up programs can be increased by some quantitative and qualitative modifications of the programs, controlled economic studies are required.