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Colorectal Cancer: Surveillance After Curative-Intent Therapy

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The ASCRS Textbook of Colon and Rectal Surgery

Abstract

There are more than 1.2 million people in the United States in survivorship care after curative resection of colorectal cancer. They face a lifetime of risk for cancer recurrence or metachronous colorectal cancer, yet there is little consensus on optimal approaches to surveillance. For patients willing and able to undergo surgical or medical therapy for recurrence, active, structured surveillance is recommended. This chapter discusses the content, supporting evidence, outcomes, and shortcomings of the major published guidelines for surveillance after curative resection for colorectal cancer.

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References

  1. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin. 2013;63(1):11–30. http://www.ncbi.nlm.nih.gov/pubmed/23335087.

    PubMed  Google Scholar 

  2. DeSantis CE, Lin CC, Mariotto AB, Siegel RL, Stein KD, Kramer JL, et al. Cancer treatment and survivorship statistics, 2014. CA Cancer J Clin. 2014;64(4):252–71. http://www.ncbi.nlm.nih.gov/pubmed/24890451.

    PubMed  Google Scholar 

  3. Vernava III A, Longo W, Virgo K, Coplin M, Wade T, Johnson F. Current follow-up strategies after resection of colon cancer. Dis Colon Rectum. 1994;37(6):573–83. doi:10.1007/BF02050993.

    Article  PubMed  Google Scholar 

  4. Grossmann EM, Johnson FE, Virgo KS, Longo WE, Fossati R. Follow-up of colorectal cancer patients after resection with curative intent—the GILDA trial. Surg Oncol. 2004;13(2–3):119–24.

    PubMed  Google Scholar 

  5. NCCN Clinical Practice Guidelines in Oncology—Genetic/familial high-risk assessment: colorectal, Version 2.2014. 2014. http://www.nccn.org/professionals/physician_gls/pdf/genetics_colon.pdf. Accessed 24 Apr 2015.

  6. Fahy BN. Follow-up after curative resection of colorectal cancer. Ann Surg Oncol. 2014;21(3):738–46. http://www.ncbi.nlm.nih.gov/pubmed/24271157.

    PubMed  Google Scholar 

  7. Cancer of the colon and rectum—SEER stat fact sheets. http://seer.cancer.gov/statfacts/html/colorect.html. Accessed 2 Apr 2015.

  8. Tsikitis VL, Malireddy K, Green EA, Christensen B, Whelan R, Hyder J, et al. Postoperative surveillance recommendations for early stage colon cancer based on results from the clinical outcomes of surgical therapy trial. J Clin Oncol. 2009;27(22):3671–6. http://jco.ascopubs.org/content/27/22/3671.abstract.

    PubMed  PubMed Central  Google Scholar 

  9. Arriola E, Navarro M, Parés D, Muñoz M, Pareja L, Figueras J, et al. Imaging techniques contribute to increased surgical rescue of relapse in the follow-up of colorectal cancer. Dis Colon Rectum. 2006;49(4):478–84. doi:10.1007/s10350-005-0280-9.

    Article  PubMed  Google Scholar 

  10. Kobayashi H, Mochizuki H, Sugihara K, Morita T, Kotake K, Teramoto T, et al. Characteristics of recurrence and surveillance tools after curative resection for colorectal cancer: a multicenter study. Surgery. 2007;141(1):67–75.

    PubMed  Google Scholar 

  11. Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg. 1999;230(3):309–18. discussion 318–21.

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Sargent D, Sobrero A, Grothey A, O’Connell MJ, Buyse M, Andre T, et al. Evidence for cure by adjuvant therapy in colon cancer: observations based on individual patient data from 20,898 patients on 18 randomized trials. J Clin Oncol. 2009;27(6):872–7. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2738431/.

    PubMed  PubMed Central  Google Scholar 

  13. Seo SI, Lim S-B, Yoon YS, Kim CW, Yu CS, Kim TW, et al. Comparison of recurrence patterns between ≤5 years and >5 years after curative operations in colorectal cancer patients. J Surg Oncol. 2013;108(1):9–13. http://www.ncbi.nlm.nih.gov/pubmed/23754582.

    PubMed  Google Scholar 

  14. Fora A, Patta A, Attwood K, Wilding G, Fakih M. Intensive radiographic and biomarker surveillance in stage II and III colorectal cancer. Oncology. 2012;82(1):41–7.

    CAS  PubMed  Google Scholar 

  15. Sargent DJ, Patiyil S, Yothers G, Haller DG, Gray R, Benedetti J, et al. End points for colon cancer adjuvant trials: observations and recommendations based on individual patient data from 20,898 patients enrolled onto 18 randomized trials from the ACCENT group. J Clin Oncol. 2007;25(29):4569–74.

    PubMed  Google Scholar 

  16. Ohlsson B, Breland U, Ekberg H, Graffner H, Tranberg KG. Follow-up after curative surgery for colorectal carcinoma. Randomized comparison with no follow-up. Dis Colon Rectum. 1995;38(6):619–26.

    CAS  PubMed  Google Scholar 

  17. Makela JT, Laitinen SO, Kairaluoma MI. Five-year follow-up after radical surgery for colorectal cancer. Results of a prospective randomized trial. Arch Surg. 1995;130(10):1062–7.

    CAS  PubMed  Google Scholar 

  18. Kjeldsen BJ, Kronborg O, Fenger C, Jorgensen OD. A prospective randomized study of follow-up after radical surgery for colorectal cancer. Br J Surg. 1997;84(5):666–9. http://www.ncbi.nlm.nih.gov/pubmed/9171758.

    CAS  PubMed  Google Scholar 

  19. Schoemaker D, Black R, Giles L, Toouli J. Yearly colonoscopy, liver CT, and chest radiography do not influence 5-year survival of colorectal cancer patients. Gastroenterology. 1998;114(1):7–14. http://www.sciencedirect.com/science/article/pii/S0016508598706262.

    CAS  PubMed  Google Scholar 

  20. Rodríguez-Moranta F, Saló J, Arcusa A, Boadas J, Piñol V, Bessa X, et al. Postoperative surveillance in patients with colorectal cancer who have undergone curative resection: a prospective, multicenter, randomized, controlled trial. J Clin Oncol. 2006;24(3):386–93.

    PubMed  Google Scholar 

  21. Pietra N, Sarli L, Costi R, Ouchemi C, Grattarola M, Peracchia A. Role of follow-up in management of local recurrences of colorectal cancer. Dis Colon Rectum. 1998;41(9):1127–33. doi:10.1007/BF02239434.

    Article  CAS  PubMed  Google Scholar 

  22. Secco GB, Fardelli R, Gianquinto D, Bonfante P, Baldi E, Ravera G, et al. Efficacy and cost of risk-adapted follow-up in patients after colorectal cancer surgery: a prospective, randomized and controlled trial. Eur J Surg Oncol. 2002;28(4):418–23. http://www.sciencedirect.com/science/article/pii/S0748798301912508.

    PubMed  Google Scholar 

  23. Primrose JN, Perera R, Gray A, Rose P, Fuller A, Corkhill A, et al. Effect of 3 to 5 years of scheduled CEA and CT follow-up to detect recurrence of colorectal cancer: the FACS randomized clinical trial. JAMA. 2014;311(3):263–70. http://www.ncbi.nlm.nih.gov/pubmed/24430319.

    CAS  PubMed  Google Scholar 

  24. Baca B, Beart RW, Etzioni DA. Surveillance after colorectal cancer resection: a systematic review. Dis Colon Rectum. 2011;54(8):1036–48.

    PubMed  Google Scholar 

  25. Jeffery M, Hickey B, Hider P. Follow up strategies for patients treated for non-metastatic colorectal cancer. Cochrane Database Syst Rev. 2007;1, CD002200. http://espace.library.uq.edu.au/view/UQ:137177.

    Google Scholar 

  26. Tjandra J, Chan MY. Follow-up after curative resection of colorectal cancer: a meta-analysis. Dis Colon Rectum. 2007;50(11):1783–99. doi:10.1007/s10350-007-9030-5.

    Article  PubMed  Google Scholar 

  27. Jain N, Pietrobon R, Hocker S, Guller U, Shankar A, Higgins LD. The relationship between surgeon and hospital volume and outcomes for shoulder arthroplasty. J Bone Joint Surg Am. 2004;86-A(3):496–505.

    Google Scholar 

  28. Pita-Fernandez S, Alhayek-Ai M, Gonzalez-Martin C, Lopez-Calvino B, Seoane-Pillado T, Pertega-Diaz S. Intensive follow-up strategies improve outcomes in nonmetastatic colorectal cancer patients after curative surgery: a systematic review and meta-analysis. Ann Oncol. 2015;26(4):644–56. doi:10.1093/annonc/mdu543.

    Article  Google Scholar 

  29. Renehan AG, Egger M, Saunders MP, O’Dwyer ST. Impact on survival of intensive follow up after curative resection for colorectal cancer: systematic review and meta-analysis of randomised trials. BMJ. 2002;324(7341):1–8.

    Google Scholar 

  30. Colofol—evaluation of the frequency of a surveillance program. http://www.colofol.com. Accessed 17 Apr 2015.

  31. Juul T, Ahlberg M, Biondo S, Emmertsen KJ, Espin E, Jimenez LM, et al. International validation of the low anterior resection syndrome score. Ann Surg. 2014;259(4):728–34. http://www.ncbi.nlm.nih.gov/pubmed/23598379.

    PubMed  Google Scholar 

  32. Peeters KCMJ, van de Velde CJH, Leer JWH, Martijn H, Junggeburt JMC, Kranenbarg EK, et al. Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients—a Dutch colorectal cancer group study. J Clin Oncol. 2005;23(25):6199–206.

    CAS  PubMed  Google Scholar 

  33. Ramsey SD, Berry K, Moinpour C, Giedzinska A, Andersen MR. Quality of life in long term survivors of colorectal cancer. Am J Gastroenterol. 2002;97(5):1228–34.

    PubMed  Google Scholar 

  34. Meyerhardt JA, Niedzwiecki D, Hollis D, Saltz LB, Hu FB, Mayer RJ, et al. Association of dietary patterns with cancer recurrence and survival in patients with stage III colon cancer. JAMA. 2007;298(7):754–64.

    CAS  PubMed  Google Scholar 

  35. McCullough ML, Gapstur SM, Shah R, Jacobs EJ, Campbell PT. Association between red and processed meat intake and mortality among colorectal cancer survivors. J Clin Oncol. 2013;31(22):2773–82.

    PubMed  PubMed Central  Google Scholar 

  36. Meyerhardt JA, Heseltine D, Niedzwiecki D, Hollis D, Saltz LB, Mayer RJ, et al. Impact of physical activity on cancer recurrence and survival in patients with stage III colon cancer: findings from CALGB 89803. J Clin Oncol. 2006;24(22):3535–41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16822843.

    PubMed  Google Scholar 

  37. Steele SR, Chang G, Hendren S, Weiser MR, Irani J, Buie WD, et al. Practice guidelines for the surveillance of patients after curative treatment of colon and rectal cancer. Dis Colon Rectum. 2015;58(8):713–25.

    Google Scholar 

  38. Chau I, Allen MJ, Cunningham D, Norman AR, Brown G, Ford HER, et al. The value of routine serum carcino-embryonic antigen measurement and computed tomography in the surveillance of patients after adjuvant chemotherapy for colorectal cancer. J Clin Oncol. 2004;22(8):1420–9.

    CAS  PubMed  Google Scholar 

  39. Graham RA, Wang S, Catalano PJ, Haller DG. Postsurgical surveillance of colon cancer: preliminary cost analysis of physician examination, carcinoembryonic antigen testing, chest X-ray, and colonoscopy. Ann Surg. 1998;228(1):59–63.

    CAS  PubMed  PubMed Central  Google Scholar 

  40. Moertel CG, Fleming TR, Macdonald JS, Haller DG, Laurie JA, Tangen C. An evaluation of the carcinoembryonic antigen (CEA) test for monitoring patients with resected colon cancer. JAMA. 1993;270(8):943–7.

    CAS  PubMed  Google Scholar 

  41. Glover C, Douse P, Kane P, Karani J, Meire H, Mohammadtaghi S, et al. Accuracy of investigations for asymptomatic colorectal liver metastases. Dis Colon Rectum. 2002;45(4):476–84.

    CAS  PubMed  Google Scholar 

  42. Carriquiry LA, Piñeyro A. Should carcinoembryonic antigen be used in the management of patients with colorectal cancer? Dis Colon Rectum. 1999;42(7):921–9.

    CAS  PubMed  Google Scholar 

  43. Tan E, Gouvas N, Nicholls RJ, Ziprin P, Xynos E, Tekkis PP. Diagnostic precision of carcinoembryonic antigen in the detection of recurrence of colorectal cancer. Surg Oncol. 2009;18(1):15–24.

    PubMed  Google Scholar 

  44. Metser U, You J, McSweeney S, Freeman M, Hendler A. Assessment of tumor recurrence in patients with colorectal cancer and elevated carcinoembryonic antigen level: FDG PET/CT versus contrast-enhanced 64-MDCT of the chest and abdomen. Am J Roentgenol. 2010;194(3):766–71.

    Google Scholar 

  45. Irvine T, Scott M, Clark CI. A small rise in CEA is sensitive for recurrence after surgery for colorectal cancer. Colorectal Dis. 2007;9(6):527–31.

    CAS  PubMed  Google Scholar 

  46. Verberne C, Wiggers T, Vermeulen KM, de Jong KP. Detection of recurrences during follow-up after liver surgery for colorectal metastases: both Carcino-Embryonic Antigen (CEA) and imaging are important. Ann Surg Oncol. 2013;20:457–63.

    PubMed  Google Scholar 

  47. Goslin R, O’Brien MJ, Steele G, Mayer R, Wilson R, Corson JM, et al. Correlation of plasma CEA and CEA tissue staining in poorly differentiated colorectal cancer. Am J Med. 1981;71(2):246–53.

    CAS  PubMed  Google Scholar 

  48. NCCN Clinical Practice Guidelines in Oncology: colon cancer. http://www.nccn.org/professionals/physician_gls/pdf/colon.pdf. Accessed 14 Apr 2015.

  49. NCCN Clinical Practice Guidelines in Oncology: rectal cancer. http://www.nccn.org/professionals/physician_gls/pdf/rectal.pdf. Accessed 14 Apr 2015.

  50. Kjeldsen BJ, Kronborg O, Fenger C, Jørgensen OD. The pattern of recurrent colorectal cancer in a prospective randomised study and the characteristics of diagnostic tests. Int J Color Dis. 1997;12(6):329–34.

    CAS  Google Scholar 

  51. Earle C, Annis R, Sussman J, Haynes AE, Vafaei A. Follow-up care, surveillance protocol, and secondary prevention measures for survivors of colorectal cancer. Toronto, ON; 2012. https://www.cancercare.on.ca/common/pages/UserFile.aspx?fileId=124839.

  52. Labianca R, Nordlinger B, Beretta GD, Mosconi S, Mandalà M, Cervantes A, et al. Early colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24 suppl 6:vi64–72. http://annonc.oxfordjournals.org/content/24/suppl_6/vi64.short.

    PubMed  Google Scholar 

  53. Anthony T, Simmang C, Hyman N, Buie D, Kim D, Cataldo P, et al. Practice parameters for the surveillance and follow-up of patients with colon and rectal cancer. Dis Colon Rectum. 2004;47(6):807–17. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15108028.

    PubMed  Google Scholar 

  54. Cummings LC, Payes JD, Cooper GS. Survival after hepatic resection in metastatic colorectal cancer: a population-based study. Cancer. 2007;109(4):718–26.

    PubMed  Google Scholar 

  55. Meyerhardt JA, Mangu PB, Flynn PJ, Korde L, Loprinzi CL, Minsky BD, et al. Follow-up care, surveillance protocol, and secondary prevention measures for survivors of colorectal cancer: American Society of Clinical Oncology clinical practice guideline endorsement. J Clin Oncol. 2013;31(35):4465–70. http://www.ncbi.nlm.nih.gov/pubmed/24220554.

    PubMed  Google Scholar 

  56. Sobhani I, Tiret E, Lebtahi R, Aparicio T, Itti E, Montravers F, et al. Early detection of recurrence by 18FDG-PET in the follow-up of patients with colorectal cancer. Br J Cancer. 2008;98(5):875–80.

    CAS  PubMed  PubMed Central  Google Scholar 

  57. Patel K, Hadar N, Lee J, Siegel BA, Hillner BE, Lau J. The lack of evidence for PET or PET/CT surveillance of patients with treated lymphoma, colorectal cancer, and head and neck cancer: a systematic review. J Nucl Med. 2013;54(9):1518–27. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3980728&tool=pmcentrez&rendertype=abstract.

    PubMed  Google Scholar 

  58. Flanagan FL, Dehdashti F, Ogunbiyi OA, Kodner IJ, Siegel BA. Utility of FDG-PET for investigating unexplained plasma CEA elevation in patients with colorectal cancer. Ann Surg. 1998;227(3):319–23.

    CAS  PubMed  PubMed Central  Google Scholar 

  59. Flamen P, Hoekstra OS, Homans F, Van Cutsem E, Maes A, Stroobants S, et al. Unexplained rising carcinoembryonic antigen (CEA) in the postoperative surveillance of colorectal cancer: the utility of positron emission tomography (PET). Eur J Cancer. 2001;37(7):862–9.

    CAS  PubMed  Google Scholar 

  60. Shen Y-Y, Liang J-A, Chen Y-K, Tsai C-Y, Kao C-H. Clinical impact of 18F-FDG-PET in the suspicion of recurrent colorectal cancer based on asymptomatically elevated serum level of carcinoembryonic antigen (CEA) in Taiwan. Hepatogastroenterology. 2006;53(69):348–50.

    PubMed  Google Scholar 

  61. Kyoto Y, Momose M, Kondo C, Itabashi M, Kameoka S, Kusakabe K. Ability of 18F-FDG PET/CT to diagnose recurrent colorectal cancer in patients with elevated CEA concentrations. Ann Nucl Med. 2010;24(5):395–401.

    CAS  PubMed  Google Scholar 

  62. Lu YY, Chen JH, Chien CR, Chen WTL, Tsai SC, Lin WY, et al. Use of FDG-PET or PET/CT to detect recurrent colorectal cancer in patients with elevated CEA: a systematic review and meta-analysis. Int J Colorectal Dis. 2013;28(8):1039–47.

    PubMed  Google Scholar 

  63. Huebner RH, Park KC, Shepherd JE, Schwimmer J, Czernin J, Phelps ME, et al. A meta-analysis of the literature for whole-body FDG PET detection of recurrent colorectal cancer. J Nucl Med. 2000;41:1177–89. http://www.ncbi.nlm.nih.gov/pubmed/10914907.

    CAS  PubMed  Google Scholar 

  64. Grossmann I, Doornbos PM, Klaase JM, de Bock GH, Wiggers T. Changing patterns of recurrent disease in colorectal cancer. Eur J Surg Oncol. 2014;40:234–9.

    CAS  PubMed  Google Scholar 

  65. Ohlsson B, Pålsson B. Follow-up after colorectal cancer surgery. Acta Oncol. 2003;42(8):816–26. doi:10.1080/02841860310019016.

    Article  PubMed  Google Scholar 

  66. Ding P, Liska D, Tang P, Shia J, Saltz L, Goodman K, et al. Pulmonary recurrence predominates after combined modality therapy for rectal cancer. Ann Surg. 2012;256(1):111–6.

    PubMed  Google Scholar 

  67. Nordholm-Carstensen A, Krarup P-M, Jorgensen LN, Wille-Jorgensen PA, Harling H. Occurrence and survival of synchronous pulmonary metastases in colorectal cancer: a nationwide cohort study. Eur J Cancer. 2014;50(2):447–56.

    PubMed  Google Scholar 

  68. Piñol V, Andreu M, Castells A, Payá A, Bessa X, Jover R. Synchronous colorectal neoplasms in patients with colorectal cancer: predisposing individual and familial factors. Dis Colon Rectum. 2004;47(7):1192–200. doi:10.1007/s10350-004-0562-7.

    Article  PubMed  Google Scholar 

  69. Van Leersum NJ, Aalbers AG, Snijders HS, Henneman D, Wouters MW, Tollenaar RA, et al. Synchronous colorectal carcinoma: a risk factor in colorectal cancer surgery. Dis Colon Rectum. 2014;57(4):460–6. http://journals.lww.com/dcrjournal/Fulltext/2014/04000/Synchronous_Colorectal_Carcinoma___A_Risk_Factor.8.aspx.

    PubMed  Google Scholar 

  70. Rex DK, Kahi CJ, Levin B, Smith RA, Bond JH, Brooks D, et al. Guidelines for colonoscopy surveillance after cancer resection: a consensus update by the American Cancer Society and the US multi-society task force on colorectal cancer. Gastroenterology. 2006;130(6):1865–71.

    PubMed  Google Scholar 

  71. Cone MM, Beck DE, Hicks TE, Rea JD, Whitlow CB, Vargas HD, et al. Timing of colonoscopy after resection for colorectal cancer: are we looking too soon? Dis Colon Rectum. 2013;56(11):1233–6. http://journals.lww.com/dcrjournal/Fulltext/2013/11000/Timing_of_Colonoscopy_After_Resection_for.7.aspx.

    CAS  PubMed  Google Scholar 

  72. Scholefield JH, Steele RJ. Guidelines for follow up after resection of colorectal cancer. Gut. 2002;51 suppl 5:v3–5. http://gut.bmj.com/content/51/suppl_5/v3.short.

    PubMed  PubMed Central  Google Scholar 

  73. Cairns SR, Scholefield JH, Steele RJ, Dunlop MG, Thomas HJW, Evans GD, et al. Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut. 2010;59(5):666–89.

    PubMed  Google Scholar 

  74. Cali RL, Pitsch RM, Thorson AG, Watson P, Tapia P, Blatchford GJ, et al. Cumulative incidence of metachronous colorectal cancer. Dis Colon Rectum. 1993;36(4):388–93.

    CAS  PubMed  Google Scholar 

  75. Wang T, Cui Y, Huang W-S, Deng Y-H, Gong W, Li C, et al. The role of postoperative colonoscopic surveillance after radical surgery for colorectal cancer: a prospective, randomized clinical study. Gastrointest Endosc. 2009;69(3, Part 2):609–15. http://www.sciencedirect.com/science/article/pii/S0016510708018397.

    PubMed  Google Scholar 

  76. Lan Y-T, Lin J-K, Li A-Y, Lin T-C, Chen W-S, Jiang J-K, et al. Metachronous colorectal cancer: necessity of post-operative colonoscopic surveillance. Int J Colorectal Dis. 2005;20(2):121–5. doi:10.1007/s00384-004-0635-z.

    Article  PubMed  Google Scholar 

  77. Barillari P, Ramacciato G, Manetti G, Bovino A, Sammartino P, Stipa V. Surveillance of colorectal cancer: effectiveness of early detection of intraluminal recurrences on prognosis and survival of patients treated for cure. Dis Colon Rectum. 1996;39(4):388–93. http://journals.lww.com/dcrjournal/Fulltext/1996/39040/Surveillance_of_colorectal_cancer__Effectiveness.5.aspx.

    CAS  PubMed  Google Scholar 

  78. Green RJ, Metlay JP, Propert K, Catalano PJ, Macdonald JS, Mayer RJ, et al. Surveillance for second primary colorectal cancer after adjuvant chemotherapy: an analysis of intergroup 0089. Ann Intern Med. 2002;136(4):261–9. doi:10.7326/0003-4819-136-4-200202190-00005.

    Article  CAS  PubMed  Google Scholar 

  79. Glimelius B, Tiret E, Cervantes A, Arnold D, Group on behalf of the EGW. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24 suppl 6:vi81–8. http://annonc.oxfordjournals.org/content/24/suppl_6/vi81.short.

    PubMed  Google Scholar 

  80. Davila RE, Rajan E, Baron TH. ASGE guideline: colorectal cancer screening and surveillance. Gastrointest Endosc. 2006;63(4):546–57. http://www.ncbi.nlm.nih.gov/pubmed/16564851.

    PubMed  Google Scholar 

  81. Mulder SA, Kranse R, Damhuis RA, Ouwendijk RJ, Kuipers EJ, van Leerdam ME. The incidence and risk factors of metachronous colorectal cancer: an indication for follow-up. Dis Colon Rectum. 2012;55(5):522–31. http://journals.lww.com/dcrjournal/Fulltext/2012/05000/The_Incidence_and_Risk_Factors_of_Metachronous.5.aspx.

    PubMed  Google Scholar 

  82. Bouvier A-M, Latournerie M, Jooste V, Lepage C, Cottet V, Faivre J. The lifelong risk of metachronous colorectal cancer justifies long-term colonoscopic follow-up. Eur J Cancer. 2008;44(4):522–7. http://www.sciencedirect.com/science/article/pii/S0959804908000129.

    PubMed  Google Scholar 

  83. Chen F, Stuart M. Colonoscopic follow-up of colorectal carcinoma. Dis Colon Rectum. 1994;37(6):568–72. doi:10.1007/BF02050992.

    Article  CAS  PubMed  Google Scholar 

  84. Battersby NJ, Coupland A, Bouliotis G, Mirza N, Williams JG. Metachronous colorectal cancer: a competing risks analysis with consideration for a stratified approach to surveillance colonoscopy. J Surg Oncol. 2014;109(5):445–50.

    PubMed  Google Scholar 

  85. Day LW, Walter LC, Velayos F. Colorectal cancer screening and surveillance in the elderly patient. Am J Gastroenterol. 2011;106(7):1197–206. doi:10.1038/ajg.2011.128.

    Article  PubMed  Google Scholar 

  86. Tran AH, Man Ngor EW, Wu BU. Surveillance colonoscopy in elderly patients: a retrospective cohort study. JAMA. 2014;90027(10):1675–82. http://www.ncbi.nlm.nih.gov/pubmed/25111954.

    Google Scholar 

  87. Winawer SJ, Stewart ET, Zauber AG, Bond JH, Ansel H, Waye JD, et al. A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy. N Engl J Med. 2000;342(24):1766–72. doi:10.1056/NEJM200006153422401.

    Article  CAS  PubMed  Google Scholar 

  88. Choi YJ, Park SH, Lee SS, Choi EK, Yu CS, Kim HC, et al. CT colonography for follow-up after surgery for colorectal cancer. AJR Am J Roentgenol. 2007;189(2):283–9.

    PubMed  Google Scholar 

  89. Kim HJ, Park SH, Pickhardt PJ, Yoon SN, Lee SS, Yee J, et al. CT colonography for combined colonic and extracolonic surveillance after curative resection of colorectal cancer. Radiology. 2010;257(3):697–704.

    PubMed  Google Scholar 

  90. Cotton PB, Durkalski VL, Pineau BC, Palesch YY, Mauldin PD, Hoffman B, et al. Computed tomographic colonography (virtual colonoscopy): a multicenter comparison with standard colonoscopy for detection of colorectal neoplasia. JAMA. 2004;291(14):1713–9.

    CAS  PubMed  Google Scholar 

  91. Zakaria S, Donohue JH, Que FG, Farnell MB, Schleck CD, Ilstrup DM, et al. Hepatic resection for colorectal metastases: value for risk scoring systems? Ann Surg. 2007;246(2):183–91.

    PubMed  PubMed Central  Google Scholar 

  92. Chao M, Gibbs P. Caution is required before recommending routine carcinoembryonic antigen and imaging follow-up for patients with early-stage colon cancer. J Clin Oncol. 2009;27(36):e279–80. http://jco.ascopubs.org/content/27/36/e279.long.

    PubMed  Google Scholar 

  93. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004;350(20):2050–9. http://www.ncbi.nlm.nih.gov/pubmed/15141043

  94. Cancer Genome Atlas Network. Comprehensive molecular characterization of human colon and rectal cancer. Nature. 2012;487(7407):330–7. http://www.ncbi.nlm.nih.gov/pubmed/22810696.

    Google Scholar 

  95. Zhuang C-L, Ye X-Z, Zhang X-D, Chen B-C, Yu Z. Enhanced recovery after surgery programs versus traditional care for colorectal surgery: a meta-analysis of randomized controlled trials. Dis Colon Rectum. 2013;56(5):667–78. doi:10.1097/DCR.0b013e3182812842.

    Article  PubMed  Google Scholar 

  96. Yamauchi M, Morikawa T, Kuchiba A, Imamura Y, Qian ZR, Nishihara R, et al. Assessment of colorectal cancer molecular features along bowel subsites challenges the conception of distinct dichotomy of proximal versus distal colorectum. Gut. 2012;61(6):847–54. http://www.ncbi.nlm.nih.gov/pubmed/22427238.

    CAS  PubMed  Google Scholar 

  97. Sauer R, Liersch T, Merkel S, Fietkau R, Hohenberger W, Hess C, et al. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol. 2012;30(16):1926–33. http://www.ncbi.nlm.nih.gov/pubmed/22529255.

    CAS  PubMed  Google Scholar 

  98. Quirke P, Steele R, Monson J, Grieve R, Khanna S, Couture J, et al. Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet. 2009;373(9666):821–8. http://www.ncbi.nlm.nih.gov/pubmed/19269520.

    PubMed  PubMed Central  Google Scholar 

  99. Van Gijn W, Marijnen CA, Nagtegaal ID, Kranenbarg EM, Putter H, Wiggers T, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol. 2011;12(6):575–82. http://www.ncbi.nlm.nih.gov/pubmed/21596621.

    PubMed  Google Scholar 

  100. Kusters M, Marijnen CA, van de Velde CJ, Rutten HJ, Lahaye MJ, Kim JH, et al. Patterns of local recurrence in rectal cancer; a study of the Dutch TME trial. Eur J Surg Oncol. 2010;36(5):470–6. http://www.ncbi.nlm.nih.gov/pubmed/20096534.

    CAS  PubMed  Google Scholar 

  101. Rasanen M, Carpelan-Holmstrom M, Mustonen H, Renkonen-Sinisalo L, Lepisto A. Pattern of rectal cancer recurrence after curative surgery. Int J Colorectal Dis. 2015;30(6):775–85. http://www.ncbi.nlm.nih.gov/pubmed/25796493.

    Google Scholar 

  102. MacFarlane JK, Ryall RD, Heald RJ. Mesorectal excision for rectal cancer. Lancet. 1993;341(8843):457–60. http://www.ncbi.nlm.nih.gov/pubmed/8094488.

    CAS  PubMed  Google Scholar 

  103. Wibe A, Rendedal PR, Svensson E, Norstein J, Eide TJ, Myrvold HE, et al. Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer. Br J Surg. 2002;89(3):327–34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11872058.

    CAS  PubMed  Google Scholar 

  104. Nagtegaal ID, van de Velde CJ, van der Worp E, Kapiteijn E, Quirke P, van Krieken JH. Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol. 2002;20(7):1729–34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11919228.

    PubMed  Google Scholar 

  105. Patel SA, Chen Y-H, Hornick JL, Catalano P, Nowak JA, Zukerberg LR, et al. Early-stage rectal cancer: clinical and pathologic prognostic markers of time to local recurrence and overall survival after resection. Dis Colon Rectum. 2014;57(4):449–59. http://www.ncbi.nlm.nih.gov/pubmed/24608301.

    PubMed  PubMed Central  Google Scholar 

  106. Park IJ, You YN, Agarwal A, Skibber JM, Rodriguez-Bigas MA, Eng C, et al. Neoadjuvant treatment response as an early response indicator for patients with rectal cancer. J Clin Oncol. 2012;30(15):1770–6. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3383178&tool=pmcentrez&rendertype=abstract.

    CAS  PubMed  PubMed Central  Google Scholar 

  107. Trakarnsanga A, Gonen M, Shia J, Goodman KA, Nash GM, Temple LK, et al. What is the significance of the circumferential margin in locally advanced rectal cancer after neoadjuvant chemoradiotherapy? Ann Surg Oncol. 2013;20(4):1179–84. http://www.ncbi.nlm.nih.gov/pubmed/23328971.

    PubMed  PubMed Central  Google Scholar 

  108. Nagtegaal ID, Quirke P. What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol. 2008;26(2):303–12. http://www.ncbi.nlm.nih.gov/pubmed/18182672.

    PubMed  Google Scholar 

  109. Lohnert MS, Doniec JM, Henne-Bruns D. Effectiveness of endoluminal sonography in the identification of occult local rectal cancer recurrences. Dis Colon Rectum. 2000;43(4):483–91. http://www.ncbi.nlm.nih.gov/pubmed/10789743.

    CAS  PubMed  Google Scholar 

  110. De Anda EH, Lee SH, Finne CO, Rothenberger DA, Madoff RD, Garcia-Aguilar J. Endorectal ultrasound in the follow-up of rectal cancer patients treated by local excision or radical surgery. Dis Colon Rectum. 2004;47(6):818–24. http://www.ncbi.nlm.nih.gov/pubmed/15085436.

    PubMed  Google Scholar 

  111. Ramirez JM, Mortensen NJ, Takeuchi N, Humphreys MM. Endoluminal ultrasonography in the follow-up of patients with rectal cancer. Br J Surg. 1994;81(5):692–4.

    CAS  PubMed  Google Scholar 

  112. Morken JJ, Baxter NN, Madoff RD, Finne 3rd CO. Endorectal ultrasound-directed biopsy: a useful technique to detect local recurrence of rectal cancer. Int J Color Dis. 2006;21(3):258–64. http://www.ncbi.nlm.nih.gov/pubmed/15942740.

    Google Scholar 

  113. Gleeson FC, Larson DW, Dozois EJ, Boardman LA, Clain JE, Rajan E, et al. Local recurrence detection following transanal excision facilitated by EUS-FNA. Hepatogastroenterology. 2012;59(116):1102–7. http://www.ncbi.nlm.nih.gov/pubmed/22281976.

    PubMed  Google Scholar 

  114. Maleki Z, Erozan Y, Geddes S, Li QK. Endorectal ultrasound-guided fine-needle aspiration: a useful diagnostic tool for perirectal and intraluminal lesions. Acta Cytol. 2013;57(1):9–18. doi:10.1159/000342919.

    Article  PubMed  Google Scholar 

  115. Lambregts DM, Cappendijk VC, Maas M, Beets GL, Beets-Tan RG. Value of MRI and diffusion-weighted MRI for the diagnosis of locally recurrent rectal cancer. Eur Radiol. 2011;21(6):1250–8. http://www.ncbi.nlm.nih.gov/pubmed/21240647.

    PubMed  PubMed Central  Google Scholar 

  116. Titu LV, Nicholson AA, Hartley JE, Breen DJ, Monson JR. Routine follow-up by magnetic resonance imaging does not improve detection of resectable local recurrences from colorectal cancer. Ann Surg. 2006;243(3):348–52. http://www.ncbi.nlm.nih.gov/pubmed/16495699.

    PubMed  PubMed Central  Google Scholar 

  117. Nash GM, Weiser MR, Guillem JG, Temple LK, Shia J, Gonen M, et al. Long-term survival after transanal excision of T1 rectal cancer. Dis Colon Rectum. 2009;52(4):577–82.

    PubMed  Google Scholar 

  118. You YN, Baxter NN, Stewart A, Nelson H. Is the increasing rate of local excision for stage I rectal cancer in the United States justified? A nationwide cohort study from the National Cancer Database. Ann Surg. 2007;245(5):726–33.

    PubMed  PubMed Central  Google Scholar 

  119. Paty PB, Nash GM, Baron P, Zakowski M, Minsky BD, Blumberg D, et al. Long-term results of local excision for rectal cancer. Ann Surg. 2002;236(4):522–30.

    PubMed  PubMed Central  Google Scholar 

  120. Mellgren A, Sirivongs P, Rothenberger DA, Madoff RD, Garcia-Aguilar J. Is local excision adequate therapy for early rectal cancer? Dis Colon Rectum. 2000;43(8):1064. http://www.ncbi.nlm.nih.gov/pubmed/10950004.

    CAS  PubMed  Google Scholar 

  121. Habr-Gama A, Perez RO, Sabbaga J, Nadalin W, São Julião GP, Gama-Rodrigues J. Increasing the rates of complete response to neoadjuvant chemoradiotherapy for distal rectal cancer: results of a prospective study using additional chemotherapy during the resting period. Dis Colon Rectum. 2009;52(12):1927–34.

    PubMed  Google Scholar 

  122. Smith JD, Ruby JA, Goodman KA, Saltz LB, Guillem JG, Weiser MR, et al. Nonoperative management of rectal cancer with complete clinical response after neoadjuvant therapy. Ann Surg. 2012;256(6):965–72. http://www.ncbi.nlm.nih.gov/pubmed/23154394.

    PubMed  Google Scholar 

  123. Smith JJ, Chow OS, Eaton A, Widmar M, Nash GM, Temple LKF, et al. Organ preservation in patients with rectal cancer with clinical complete response after neoadjuvant therapy. J Clin Oncol. 2015;33(supp 3):a509. http://meetinglibrary.asco.org/content/140433-158.

    Google Scholar 

  124. Weiser MR, Beets-Tan R, Beets G. Management of complete response after chemoradiation in rectal cancer. Surg Oncol Clin N Am. 2014;23(1):113–25. http://www.ncbi.nlm.nih.gov/pubmed/24267169.

    PubMed  Google Scholar 

  125. Habr-Gama A, Perez RO, Proscurshim I, Campos FG, Nadalin W, Kiss D, et al. Patterns of failure and survival for nonoperative treatment of stage c0 distal rectal cancer following neoadjuvant chemoradiation therapy. J Gastrointest Surg. 2006;10(10):1319. http://www.ncbi.nlm.nih.gov/pubmed/17175450.

    PubMed  Google Scholar 

  126. Castells A, Bessa X, Daniels M, Ascaso C, Lacy AM, García-Valdecasas JC, et al. Value of postoperative surveillance after radical surgery for colorectal cancer: results of a cohort study. Dis Colon Rectum. 1998;41(6):714–23. discussion 723–4.

    CAS  PubMed  Google Scholar 

  127. Laubert T, Bader FG, Oevermann E, Jungbluth T, Unger L, Roblick UJ, et al. Intensified surveillance after surgery for colorectal cancer significantly improves survival. Eur J Med Res. 2010;15(1):25–30.

    PubMed  PubMed Central  Google Scholar 

  128. Vargas GM, Sheffield KM, Parmar AD, Han Y, Brown KM, Riall TS. Physician follow-up and observation of guidelines in the post treatment surveillance of colorectal cancer. Surgery. 2013;154(2):244–55. doi:10.1016/j.surg.2013.04.013.

    Article  PubMed  Google Scholar 

  129. Sisler JJ, Seo B, Katz A, Shu E, Chateau D, Czaykowski P, et al. Concordance with ASCO guidelines for surveillance after colorectal cancer treatment: a population-based analysis. J Oncol Pract. 2012;8(4):e69–79. http://jop.ascopubs.org/content/8/4/e69.abstract.

    PubMed  PubMed Central  Google Scholar 

  130. Cheung WY, Pond GR, Rother M, Krzyzanowska MK, Swallow C, Brierley J, et al. Adherence to surveillance guidelines after curative resection for stage II/III colorectal cancer. Clin Colorectal Cancer. 2008;7(3):191–6. http://www.sciencedirect.com/science/article/pii/S1533002811704194.

    PubMed  Google Scholar 

  131. Grossmann I, de Bock GH, van de Velde CJH, Kievit J, Wiggers T. Results of a national survey among Dutch surgeons treating patients with colorectal carcinoma. Current opinion about follow-up, treatment of metastasis, and reasons to revise follow-up practice. Colorectal Dis. 2007;9(9):787–92.

    CAS  PubMed  Google Scholar 

  132. Van Steenbergen LN, de Hingh IHJT, Rutten HJT, Rijk MCM, Orsini RG, Coebergh JWW, et al. Large variation between hospitals in follow-up for colorectal cancer in southern Netherlands. Int J Colorectal Dis. 2013;28(9):1257–65. doi:10.1007/s00384-013-1693-x.

    Article  PubMed  Google Scholar 

  133. Søreide K, Træland JH, Stokkeland PJ, Glomsaker T, Søreide JA, Kørner H. Adherence to national guidelines for surveillance after curative resection of nonmetastatic colon and rectum cancer: a survey among Norwegian gastrointestinal surgeons. Colorectal Dis. 2012;14(3):320–4. doi:10.1111/j.1463-1318.2011.02631.x.

    Article  PubMed  Google Scholar 

  134. Cooper GS, Kou TD, Reynolds HL. Receipt of guideline-recommended follow-up in older colorectal cancer survivors. Cancer. 2008;113(8):2029–37. doi:10.1002/cncr.23823.

    Article  PubMed  Google Scholar 

  135. Giordano P, Efron J, Vernava AM, Weiss EG, Nogueras JJ, Wexner SD. Strategies of follow-up for colorectal cancer: a survey of the American society of colon and rectal surgeons. Tech Coloproctol. 2006;10(3):199–207.

    CAS  PubMed  Google Scholar 

  136. Cardella J, Coburn NG, Gagliardi A, Maier B-A, Greco E, Last L, et al. Compliance, attitudes and barriers to post-operative colorectal cancer follow-up. J Eval Clin Pract. 2008;14(3):407–15. doi:10.1111/j.1365-2753.2007.00880.x.

    Article  PubMed  Google Scholar 

  137. Wattchow DA, Weller DP, Esterman AJ, Pilotto L. General practice vs. surgical-based follow-up for patients with colon cancer: randomised controlled trial. Br J Cancer. 2006;94(8):1116–21.

    CAS  PubMed  PubMed Central  Google Scholar 

  138. Augestad KM, Norum J, Dehof S, Aspevik R, Ringberg U, Nestvold T, et al. Cost-effectiveness and quality of life in surgeon versus general practitioner-organised colon cancer surveillance: a randomised controlled trial. BMJ Open. 2013;3(4):e002391. http://bmjopen.bmj.com/content/3/4/e002391.abstract.

    PubMed  PubMed Central  Google Scholar 

  139. Haggstrom D, Arora N, Helft P, Clayman M, Oakley-Girvan I. Follow-up care delivery among colorectal cancer survivors most often seen by primary and subspecialty care physicians. J Gen Intern Med. 2009;24(2):472–9. doi:10.1007/s11606-009-1017-6.

    Article  PubMed Central  Google Scholar 

  140. Standeven L, Price Hiller J, Mulder K, Zhu G, Ghosh S, Spratlin JL. Impact of a dedicated cancer center surveillance program on guideline adherence for patients with stage II and III colorectal cancer. Clin Colorectal Cancer. 2013;12(2):103–12. doi:10.1016/j.clcc.2012.09.006.

    Article  PubMed  Google Scholar 

  141. Strand E, Nygren I, Bergkvist L, Smedh K. Nurse or surgeon follow-up after rectal cancer: a randomized trial. Colorectal Dis. 2011;13(9):999–1003. doi:10.1111/j.1463-1318.2010.02317.x.

    Article  CAS  PubMed  Google Scholar 

  142. Papagrigoriadis S, Heyman B. Patients’ views on follow up of colorectal cancer: implications for risk communication and decision making. Postgrad Med J. 2003;79(933):403–7. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1742752/.

    CAS  PubMed  PubMed Central  Google Scholar 

  143. Kjeldsen BJ, Thorsen H, Whalley D, Kronborg O. Influence of follow-up on health-related quality of life after radical surgery for colorectal cancer. Scand J Gastroenterol. 1999;34(5):509–15.

    CAS  PubMed  Google Scholar 

  144. Stiggelbout AM, de Haes JC, Vree R, van de Velde CJ, Bruijninckx CM, van Groningen K, et al. Follow-up of colorectal cancer patients: quality of life and attitudes towards follow-up. Br J Cancer. 1997;75(6):914–20. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2063387/.

    CAS  PubMed  PubMed Central  Google Scholar 

  145. Virgo KS, Vernava AM, Longo WE, McKirgan LW, Johnson FE. Cost of patient follow-up after potentially curative colorectal cancer treatment. JAMA. 1995;273(23):1837–41.

    CAS  PubMed  Google Scholar 

  146. Dinan MA, Curtis LH, Hammill BG, Patz EF, Abernethy AP, Shea AM, et al. Changes in the use and costs of diagnostic imaging among Medicare beneficiaries with cancer, 1999–2006. JAMA. 2010;303(16):1625–31.

    CAS  PubMed  Google Scholar 

  147. Audisio R, Setti-Carraro P, Segala M, Capko D, Andreoni B, Tiberio G. Follow-up in colorectal cancer patients: a cost-benefit analysis. Ann Surg Oncol. 1996;3(4):349–57. doi:10.1007/BF02305664.

    Article  CAS  PubMed  Google Scholar 

  148. Renehan AG, O’Dwyer ST, Whynes DK, Renehan AG, O’Dwyer ST, Whynes DK. Cost effectiveness analysis of intensive versus conventional follow up after curative resection for colorectal cancer. BMJ Br Med J. 2004;328(7431):81. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC314047/.

    Google Scholar 

  149. Borie F, Combescure C, Daurès J-P, Trétarre B, Millat B. Cost-effectiveness of two follow-up strategies for curative resection of colorectal cancer: comparative study using a markov model. World J Surg. 2004;28(6):563–9. doi:10.1007/s00268-004-7256-0.

    Article  PubMed  Google Scholar 

  150. Longley DB, McDermott U, Johnston PG. Predictive markers for colorectal cancer: current status and future prospects. Clin Colorectal Cancer. 2003;2(4):223–30.

    CAS  PubMed  Google Scholar 

  151. Rose J, Augestad K, Kong C, Meropol N, Kattan M, Hong Q, et al. A simulation model of colorectal cancer surveillance and recurrence. BMC Med Inform Decis Mak. 2014;14(1):1–13. doi:10.1186/1472-6947-14-29.

    Article  Google Scholar 

  152. Radespiel-Tröger M, Hohenberger W, Reingruber B. Improved prediction of recurrence after curative resection of colon carcinoma using tree-based risk stratification. Cancer. 2004;100(5):958–67. doi:10.1002/cncr.20065.

    Article  PubMed  Google Scholar 

  153. Soreide K. Endoscopic surveillance after curative surgery for sporadic colorectal cancer: patient-tailored, tumor-targeted or biology-driven? Scand J Gastroenterol. 2010;45(10):1255–61.

    PubMed  Google Scholar 

  154. Johnson FE, Virgo KS, Grossmann EM, Longo WE, Fossati R. Colorectal cancer patient follow-up following surgery with curative intent: the GILDA trial. J Clin Oncol. 2004;22(14 suppl):3645. http://hwmaint.meeting.ascopubs.org/cgi/content/abstract/22/14_suppl/3645.

    Google Scholar 

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Regenbogen, S.E., Hardiman, K.M. (2016). Colorectal Cancer: Surveillance After Curative-Intent Therapy. In: Steele, S.R., Hull, T.L., Read, T.E., Saclarides, T.J., Senagore, A.J., Whitlow, C.B. (eds) The ASCRS Textbook of Colon and Rectal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-25970-3_34

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