Postsurgical surveillance: How intensive should it be?

The best target group for surveillance after curative surgery is the stage III and postcurative stage IV disease group of patients. Most patients who relapse will do so 3 to 5 years after surgery. Newer drugs might delay the relapse period. Overall, only a small number of patients will benefit. There is a need for large, well designed, randomized studies, but these are difficult to do. Additional techniques will have to be validated as they come along. A general recommendation at the present time could be: physician evaluation, carcinoembryonic antigen testing, liver imaging, and colonoscopy. The frequency of these modalities at 3 and 6 months seems reasonable knowing that there is no final survival advantage demonstrated by randomized studies as of yet.