Outcomes of intensive surveillance after resection of hepatic colorectal metastases

Abstract

Background: The impact of computed tomography (CT)-based follow-up for the detection of resectable disease recurrence following surgery for colorectal liver metastases (CRLM) was evaluated. Methods: Some 705 patients undergoing resection of CRLM between January 1993 and March 2007 were included. Surveillance comprised 3-monthly CT (thorax, abdomen and pelvis) in the first 2 years after surgery, 6 monthly for 3 years and annually from years 6 to 10. Survival differences following recurrence between patients managed surgically and palliatively were determined, and the cost was calculated. Results: Five-year disease-free and overall survival rates were 28·3 and 32·3 per cent respectively. Of 402 patients who developed recurrence within 2 years, 88 were treated with liver resection alone and 36 with lung and/or liver resection. Their 5-year overall survival rates were 31 and 30 per cent respectively, compared with 3·9 per cent in 278 patients managed palliatively (P < 0·001). For each 3-month interval during the first year of follow-up, patients with recurrence treated surgically had better overall survival than those treated palliatively. The cost of surveillance that identified 124 patients amenable to further resection was £12 338 per operated recurrence. Assuming that patients with recurrence gained 5 years' survival, the mean survival gain was 4·28 years per resection and the cost per life-year gained was £2883. Conclusion: Intensive 3-monthly CT surveillance after liver resection for CRLM detects recurrence that is amenable to further resection in a considerable number of patients. These patients have significantly better survival with a reasonable cost per life-year gained. © 2010 British Journal of Surgery Society Ltd.