The postoperative guideline adherence for colonoscopy is significantly higher than that compared with CEA testing and imaging.
•CEA testing and imaging had sub-optimal guideline adherence (<65% compliance to both surveillance strategies).
•Of the studies that examined ASCO guideline adherence, colonoscopy compliance was the highest, followed by imaging and CEA.
•Guideline adherence to CEA was lower than both colonoscopy and imaging among all subgroups of patients.
AbstractIntroductionAlmost one-third of patients with colorectal cancer (CRC) experience recurrence after resection. Adherence to surveillance guidelines largely dictates efficacy in early detection of recurrence. We sought to assess and compare adherence to postoperative surveillance guidelines for colonoscopy, imaging, and Carcinoembryonic Antigen (CEA).
MethodsPubMed, Medline, Embase, Scopus, Cochrane, Web of Science, and CINAHL were systematically searched. Random-effects meta-analysis was performed and pooled adherence to each surveillance strategy was assessed for CEA, imaging, and colonoscopy.
ResultsOverall 14 studies (55,895 patients) met the inclusion criteria. Adherence to colonoscopy guidelines was the highest (70%, 95%CI 67–73), followed by imaging (63%, 95%CI 47–80), and CEA (54%; 95%CI 42–66). Among 7 (50%) studies that examined adherence to the American Society of Clinical Oncology guidelines, compliance with colonoscopy was the highest (73%; 95% CI 70–76), followed by imaging (58%; 95% CI 37–78), and CEA (45%; 95%CI 37–52). Of note, guideline adherence to CEA testing was much lower than colonoscopy among patients with colon (OR 0.21; 95%CI 0.20–0.22) and rectal cancer (OR 0.25; 95%CI 0.23–0.28) (both p < 0.05). This was also noted when compared with imaging recommendations among older patients (OR = 0.62; 95%CI 0.42–0.93) and patients with stage II, (OR = 0.80; 95%CI 0.76–0.84) and stage III disease (OR = 0.88; 95%CI 0.82–0.94) (all p < 0.05).
ConclusionWhile guideline adherence to postoperative surveillance with colonoscopy was high, adherence to CEA testing and imaging surveillance strategies was markedly lower following CRC resection. Future studies should investigate avenues to improve compliance with surveillance guidelines among health care providers and patients to optimize postoperative follow-up for CRC.
KeywordsColorectal cancer
Surveillance
Postoperative adherence
View Abstract© 2023 Elsevier Ltd. All rights reserved.
留言 (0)