Consensus and controversies regarding follow-up after curative intent treatment of non-metastatic colorectal cancer: a synopsis of guidelines used in countries represented in ESCP.

AIM: It is common clinical practice to follow patients for a period of years after curative intent treatment of non-metastatic colorectal cancer, but follow-up strategies vary widely. The aim of this systematic review was to provide an overview of recommendations in guidelines from ESCP member countries on this topic, with supporting evidence. METHODS: A systematic search of Medline, Embase and guidelines databases Tripdatabase, BMJ Best Practice and Guidelines International Network was performed. Quality assessment included usage of the AGREE-II tool. All topics with recommendations from included guidelines were identified and categorized. For each subtopic, a conclusion was made followed by the degree of consensus and the highest level of evidence. RESULTS: Twenty one guidelines were included. The majority recommended that structured follow-up should be offered, except for patients where treatment of recurrence would be inappropriate. It was generally agreed that clinical visits, CEA measurement, and liver imaging should be part of follow-up, based on high level of evidence, although frequency is controversial. There was also consensus on imaging of the chest and pelvis in rectal cancer, as well as endoscopy, based on lower levels of evidence and with a level of intensity that was contradictory. CONCLUSION: In available guidelines, multimodality follow-up after curative intent treatment of colorectal cancer is widely recommended, but exact content and intensity is highly controversial. International agreement on the optimal follow-up schedule is unlikely to be achieved on current evidence, and further research should re-focus on individualized 'patient-driven' follow-up and new biomarkers. This article is protected by copyright. All rights reserved.