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Canadian Journal of Gastroenterology and Hepatology
Volume 28, Issue 8, Pages 427-433
Original Article

Surveillance Patterns After Curative-Intent Colorectal Cancer Surgery in Ontario

Jensen Tan,1 Jennifer Muir,1 Natalie Coburn,1,2 Simron Singh,2 David Hodgson,3,4 Refik Saskin,3 Alex Kiss,3,5 Lawrence Paszat,2,3 Abraham El-Sedfy,2,6 Eva Grunfeld,3,7 Craig Earle,2,3 and Calvin Law1,2,3,5

1Department of General Surgery, University of Toronto, Toronto, Ontario, Canada
2Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
3Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada
4University Health Network, Toronto, Ontario, Canada
5Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
6Department of Surgery, Saint Barnabas Medical Center, Livingston, New Jersey, USA
7Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada

Received 27 January 2014; Accepted 9 June 2014

Copyright © 2014 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


BACKGROUND: Postoperative surveillance following curative-intent resection of colorectal cancer (CRC) is variably performed due to existing guideline differences and to the limited data supporting different strategies.

OBJECTIVES: To examine population-based rates of surveillance imaging and endoscopy in patients in Ontario following curative-intent resection of CRC with no evidence of recurrence, as well as patient or disease factors that may predispose certain groups to more frequent versus less frequent surveillance; to provide insight to the care patients receive in the presence of conflicting guidelines, in efforts to help improve care of CRC survivors by identifying any potential underuse or overuse of particular surveillance modalities, or inequalities in access to surveillance.

METHOD: A retrospective cohort study was conducted using data from the Ontario Cancer Registry and several linked databases. Ontario patients undergoing curative-intent CRC resection from 2003 to 2007 were identified, excluding patients with probable disease relapse. In the five-year period following surgery, the number of imaging and endoscopic examinations was determined.

RESULTS: There were 4960 patients included in the study. Over the five-year postoperative period, the highest proportion of patients who underwent postoperative surveillance received the following number of tests for each modality examined: one to three abdominopelvic computed tomography (CT) scans (n=2073 [41.8%]); one to three abdominal ultrasounds (n=2443 [49.3%]); no chest CTs, one to three chest x-rays (n=2385 [48.1%]); and two endoscopies (n=1845 [37.2%]). Odds of not receiving any abdominopelvic imaging (CT or abdominal ultrasound) were higher in those who did not receive adjuvant chemo-therapy (OR 6.99 [95% CI 5.26 to 9.35]) or those living in certain geographical areas, but were independent of age, sex and income. Nearly all patients (n=4473 [90.2%]) underwent ≥1 endoscopy at some point during the follow-up period.

CONCLUSION: In contrast to findings from similar studies in other jurisdictions, most Ontario CRC survivors receive postoperative surveillance with imaging and endoscopy, and care is equitable across sociodemographic groups, although unexplained geographical variation in practice exists and warrants further investigation.