INVESTIGATION, FOLLOW‐UP AND RECURRENCE AFTER RESECTION OF COLORECTAL CANCER

Abstract

A study was undertaken to determine the patterns of management in the 2 years following resection of colorectal cancer by Victorian surgeons. Patients were identified by the Victorian Cancer Register as having colorectal cancer diagnosed between 1 July and 31 December 1987. The surgeon of each of the 947 eligible patients who underwent surgery was sent a questionnaire seeking information about the pre‐operative investigation. type of surgery and subsequent line of referral. Only 16% of colonic cancers and 39% of rectal cancers were biopsied pre‐operatively and colonoscopy was undertaken in one‐half and one‐third respectively. Of the 737 responses, 555 patients were considered to have had curative surgery, and details of their follow‐up during the four 6‐month periods following surgery was analysed; this includes the effect of tumour stage and surgeon activity on the use and frequency of each test. Most patients had a clinical examination in each of the 6 month periods, but almost half did not have a colonoscopy and two‐thirds did not have the serum CEA level measured at all. Only one in eight had a chest X‐ray and fewer had the liver scanned during this 2 year period. Eighty‐two patients (20% of those satisfactorily followed) suffered a recurrence during this period. Twenty‐six were asymptomatic at the time of recurrence and were diagnosed by a routine test and of these, eight were diagnosed by tests used infrequently. Sixteen (20%) were considered surgically curable.