Detectie van recidiverend rectumcarcinoom tijdens follow-up Thijs Wieldraaijer, AMC

Introduction Netherlands 15,000 new patients with colorectal cancer Growing number of survivors Follow-up secondary  primary care Limited data on colon, none on rectal cancer Comparable schedule Aim In what way are recurrences detected? Scheduled consultation? (Diagnostic) examination? Symptoms? Patients Curative treatment of rectal carcinoma stages I-III Exclusion – all patients not eligible for regular follow-up Stage IV disease, no scheduled FU, IBD, >2 synchronous tumors, in-hospital deaths, hereditary carcinoma Methods Retrospective cohort 2 hospitals Rectal carcinoma All patients treated 2007-2014 All patient files Recorded patient characteristics Examinations (and missing examinations) When recurrent disease  all additional information Statistics – Chi-square, MANOVA, Kaplan-Meier

Results 501 patients treated – 378 met inclusion criteria Median follow-up – 30 months (IQR 15–49) 64 recurrences (17%) - 55 detected during scheduled follow-up (86%) - 9 in between scheduled visits (14%) - No correlation with missed follow-up examinations Median time till detection – 15 months. < 3 years – 97% 1. Detection during scheduled follow-up (N=55) 53 patients no symptoms Radiographic examination – 34 patients (62%) - CT-scan (N=13) - Chest radiograph (N=11) - Ultrasound (N=10) CEA level – 27 patients (49%) - Median value 11.3 µg/L (5.5 µg/L increase) Both radiographic and CEA level – 9 patients (17%) 2. Detection in between follow-up (N=9) 5 patients – treatment of postoperative complication/reversal colostomy 4 patients – symptoms Jaundice, weight loss, strangury, abdominal pain with fever

t.wieldraaijer@amc.uva.nl Results Median follow-up after detection of recurrence – 36 months (IQR 23-55) 1. Detection during scheduled follow-up (N=55) 33 patients (60%) re-operated with curative intent 16 patients (29%) palliative treatment 2. Detection in between follow-up (N=9) 2 patients (22%) re-operated with curative intent 5 patients (56%) palliative treatment p=0.001 Results Curatively treated patients – 17% develop recurrent disease Majority during scheduled consultations with standard examinations Within 3 years after surgery Follow-up schedule seems efficient Follow-up schedule straightforward Whether GPs can perform follow-up protocol similar  Next study t.wieldraaijer@amc.uva.nl