Is More Intensive Abdominal Computed Tomography Scanning after Radical Resection for Stage II and III Colorectal Cancer Necessary?

背景　根據目前的NCCN指引，在第二期和第三期的大腸直腸癌接受完根除手術，腹部電腦斷層追蹤建議從一年後開始，但是很多病人和醫師並不會滿足這樣的最基本的追蹤。本篇研究的目的在於評估腫瘤復發率是否夠高而需要執行更密集的術後腹部電腦斷層檢查。方法　從三軍總醫院的癌症登記資料庫搜尋，從2007年1月到2011年12月，在單一醫學中心診斷的出的第二和第三期大腸直腸癌，至少接受根除手術治療，從術後開始至第十八個月止，發生可被腹部電腦斷層偵測出的腫瘤復發或轉移的發生率。結果　總計475位病人符合篩選條件，其中256人為男性，219人為女性，平均年齡為66歲。有237位為大腸直腸癌第二期，238人為第三期。第一年的腫瘤復發率為5.4%，如果僅計算可被腹部電腦斷層偵測到的轉移，第一年則為3.5%。結論　第二期及第三期大腸直腸癌的追蹤，在一年內發生可被腹部電腦斷層偵測到轉移的機率是很低的（分別是1.6%及5.4%），在第十八個月也僅2.1%及5.8%所以採用更密集的追蹤腹部電腦斷層顯示並不需要，而且術後第一次接受電腦斷層的時間再延長似乎也是安全的。

關鍵字

大腸直腸癌；術後追蹤；電腦斷層掃描

並列摘要

Purpose. Current National Comprehensive Cancer Network guidelines recommend abdominal computed tomography (CT) surveillance after radical resection for stage II or III colorectal cancer beginning 1 year after resection. However, this minimalist approach may not be sufficient. This study aimed to determine whether the incidence of disease recurrence or metastasis could justify more intensive abdominal CT after radical surgery. Patients and Methods. We searched the Cancer Registry database of the Tri-Service General Hospital between January 2007 and December 2011 and analyzed the incidence of disease recurrence detected by using abdominal CT scanning. All patients undergoing radical resection for newly diagnosed colorectal cancer were included. Exclusion criteria were tumors of TNM stage 0, I or IV; lack of adequate staging to rule out distant or residual disease; and a lack of monitoring with a regular surveillance program. Results. In total, 475 patients met the inclusion criteria; 237 and 238 patients had stage II and III disease, respectively. The overall tumor recurrence rate and the incidence of recurrences detected by using abdominal CT in the first year was 5.4% (n = 26) and 3.5% (n = 17), respectively. Conclusion. After radical resection for stage II and III colorectal cancer, the incidence of abdominal CT-detected recurrences in the first year is rare (3.5%). Abdominal CT within the first year after radical resection for stage II and III colorectal cancer seems to be unnecessary. Furthermore, the incidence of recurrence is low in the first year (1.6% and 5.4%), and it remains low in the first 18 months, with incidences of 2.1% and 5.8% for stages II and III, respectively. In our study, it seems safe to extend the time until the first abdominal CT in stage II colorectal cancer after radical resection.

並列關鍵字

Colorectal cancer ； Resection ； Computed tomography

國際替代計量

Is More Intensive Abdominal Computed Tomography Scanning after Radical Resection for Stage II and III Colorectal Cancer Necessary?

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