First Alert for Recurrence During Follow-up After Potentially Curative Resection for Colorectal Carcinoma: CA 19-9 Should Be Included in Surveillance Programs

Background: The aim of this study was to evaluate the contribution of each examination included in the postoperative surveillance program, especially that of serum tumor markers. Patients and Methods: Patients who underwent curative surgery for colorectal carcinoma (CRC) from January 2000 to December 2006 were enrolled. The postoperative surveillance program in our department includes tumor marker ( carcinoembryonic antigen [CEA] and carbohydrate antigen [CA] 19-9) measurement every 3 months for 5 years, chest radiograph or chest computed tomography (CT) every 3 months for 2 years and then every 6 months until 5 years, and abdominal CT every 3 months for 2 years and then every 6 months until 5 years. The first examination that revealed abnormality in patients who developed recurrence was analyzed. Results: During the study period, 105 recurrences were diagnosed. There were 45 hepatic recurrences, 23 local recurrences, 20 pulmonary recurrences, 16 lymph node recurrences, and 10 peritoneal recurrences. Computed tomography, CEA, and CA 19-9 were the first abnormal examination(s) in 77, 23, and 26 patients, respectively. Tumor markers detected the recurrence earlier than did CT in 27% of patients. CEA and CA 19-9 equally contributed to detection with respect to the number of patients, while the sites of detected recurrences differed. Conclusion: For early detection of occult recurrence of CRC, CT was the most reliable modality. On the other hand, tumor markers were also relevant. Given the recent advances in multimodal approaches for advanced CRC, the combination of CT, CEA, and CA 19-9, which is currently not included in guidelines, should be routinely performed.