Intensive follow-up strategies after radical surgery for nonmetastatic colorectal cancer: A systematic review and meta-analysis of randomized controlled trials

Abstract

Background Intensive follow-up after surgery for colorectal cancers is common in clinical practice, but evidence of a survival benefit is limited. Objective To conduct a systematic review and meta-analysis on the effects of follow-up strategies for nonmetastatic colorectal cancer. Data sources We searched Medline, Embase, and CENTRAL databases through May 30, 2018. Study selection We included randomized clinical trials evaluating intensive follow-up versus less follow-up in patients with nonmetastatic colorectal cancer. Interventions Intensive follow-up Main outcomes measures Overall survival. Results The analyses included 17 trials with a total of 8039 patients. Compared with less follow-up, intensive follow-up significantly improved overall survival in patients with nonmetastatic colorectal cancer after radical surgery (HR 0.85, 95% CI 0.74–0.97, P = 0.01; I2 = 30%; high quality). Subgroup analyses showed that differences between intensive-frequency and intensive-test follow-up (P = 0.04) and between short interval and long interval of follow-up (P = 0.02) in favor of the former one. Limitations Clinical heterogeneity of interventions Conclusions For patients with nonmetastatic colorectal cancer after curative resection, intensive followup strategy was associated with an improvement in overall survival compared with less follow-up strategy. Intensive-frequency follow-up strategy was associated with a greater reduction in mortality compared with intensive-test follow-up strategy.