KEY POINTS * Pooled analyses of prospective trials have demonstrated an overall survival benefit of intensive postoperative surveillance in patients with stage I–III colorectal cancer (CRC);

however, individual studies used highly heterogeneous surveillance schemes * The overall survival benefit of intensive surveillance is only partly due to improved cancer-specific survival;

other contributing factors include the treatment of comorbidities owing to frequent contact with medical professionals * For patients with stage I–III CRC, no optimal diagnostic tool or

frequency of patient visits has been established; regular follow-up assessment by a clinician seem to be the most-important factor * Colonoscopies are generally performed at 6, 30 and 60

effectiveness of surveillance after treatment of patients with stage IV CRC with curative intent, and thus randomized trials are also needed to address this issue ABSTRACT Treatments for

colorectal cancer (CRC) of all stages have evolved considerably over the past two decades, resulting in improved long-term outcomes. After curative treatment, however, 30% of patients with

stage I–III and up to 65% of patients with stage IV CRC develop recurrent disease. Thus, patients are routinely offered surveillance in order to detect disease recurrence at an early,

asymptomatic stage, with the intention of improving survival. Nevertheless, controversy continues to surround the optimal surveillance protocols. For patients with stage I–III CRC,

more-intensive surveillance improves overall survival compared with less-intensive or no surveillance, probably owing to improved outcomes after cancer recurrence, as well as proactive

treatment of other conditions detected opportunistically. The benefit of surveillance after curative treatment of stage IV CRC is more controversial, but might be justified because repeat

resection can improve overall survival and 20% of these patients are eligible for such treatment with curative intent. No trials have assessed the optimal follow-up approach after curative

resection of metastatic CRC, and similarly to surveillance of patients with stage I–III disease, most programmes are more intensive during the first 3 years than at later time points.

Herein, we provide a comprehensive overview of surveillance strategies for patients with CRC, and discuss the future development of patient-centred programmes. Access through your

institution Buy or subscribe This is a preview of subscription content, access via your institution ACCESS OPTIONS Access through your institution Subscribe to this journal Receive 12 print

issues and online access $209.00 per year only $17.42 per issue Learn more Buy this article * Purchase on SpringerLink * Instant access to full article PDF Buy now Prices may be subject to

local taxes which are calculated during checkout ADDITIONAL ACCESS OPTIONS: * Log in * Learn about institutional subscriptions * Read our FAQs * Contact customer support SIMILAR CONTENT

BEING VIEWED BY OTHERS REVISITING THE SURVIVAL PARADOX BETWEEN STAGE IIB/C AND IIIA COLON CANCER Article Open access 27 September 2024 LONG-TERM OUTCOMES AND LYMPH NODE METASTASIS FOLLOWING

ENDOSCOPIC RESECTION WITH ADDITIONAL SURGERY OR PRIMARY SURGERY FOR T1 COLORECTAL CANCER Article Open access 20 January 2025 COLORECTAL LIVER METASTASIS: MOLECULAR MECHANISM AND

INTERVENTIONAL THERAPY Article Open access 04 March 2022 REFERENCES * Kuipers, E. J. _ et al_. Colorectal cancer. _Nat. Rev. Dis. Primers_ 1, 15065 (2015). PubMed  PubMed Central  Google

Scholar  * Torre, L. A. _ et al_. Global cancer statistics, 2012. _CA Cancer J. Clin._ 65, 87–108 (2015). Article  PubMed  Google Scholar  * Elferink, M. A. _ et al_. Marked improvements in

survival of patients with rectal cancer in the Netherlands following changes in therapy, 1989–2006. _Eur. J. Cancer_ 46, 1421–1429 (2010). CAS  PubMed  Google Scholar  * van der Pool, A. E.

_ et al_. Trends in incidence, treatment and survival of patients with stage IV colorectal cancer: a population-based series. _Colorectal Dis._ 14, 56–61 (2012). CAS  PubMed  Google Scholar

  * van Steenbergen, L. N. _ et al_. Improved survival of colon cancer due to improved treatment and detection: a nationwide population-based study in the Netherlands 1989–2006. _Ann.

Oncol._ 21, 2206–2212 (2010). CAS  PubMed  Google Scholar  * Schreuders, E. H. _ et al_. Colorectal cancer screening: a global overview of existing programmes. _Gut_ 64, 1637–1649 (2015).

PubMed  Google Scholar  * Kuipers, E. J., Rosch, T. & Bretthauer, M. Colorectal cancer screening — optimizing current strategies and new directions. _Nat. Rev. Clin. Oncol._ 10, 130–142

(2013). CAS  PubMed  Google Scholar  * Pita-Fernández, S. _ et al_. Intensive follow-up strategies improve outcomes in nonmetastatic colorectal cancer patients after curative surgery: a

systematic review and meta-analysis. _Ann. Oncol._ 26, 644–656 (2015). PubMed  Google Scholar  * Rose, J., Augestad, K. M. & Cooper, G. S. Colorectal cancer surveillance: what's new

and what's next. _World J. Gastroenterol._ 20, 1887–1897 (2014). PubMed  PubMed Central  Google Scholar  * de Jong, M. C. _ et al_. Rates and patterns of recurrence following curative

intent surgery for colorectal liver metastasis: an international multi-institutional analysis of 1669 patients. _Ann. Surg._ 250, 440–448 (2009). PubMed  Google Scholar  * Elias, D. _ et

al_. Peritoneal colorectal carcinomatosis treated with surgery and perioperative intraperitoneal chemotherapy: retrospective analysis of 523 patients from a multicentric French study. _J.

Clin. Oncol._ 28, 63–68 (2010). PubMed  Google Scholar  * Glehen, O. _ et al_. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal

carcinomatosis from colorectal cancer: a multi-institutional study. _J. Clin. Oncol._ 22, 3284–3292 (2004). CAS  PubMed  Google Scholar  * Jones, R. P. _ et al_. Systematic review and

meta-analysis of follow-up after hepatectomy for colorectal liver metastases. _Br. J. Surg._ 99, 477–486 (2012). CAS  PubMed  Google Scholar  * Pfannschmidt, J., Dienemann, H. &

Hoffmann, H. Surgical resection of pulmonary metastases from colorectal cancer: a systematic review of published series. _Ann. Thorac. Surg._ 84, 324–338 (2007). PubMed  Google Scholar  *

Verwaal, V. J. _ et al_. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal

carcinomatosis of colorectal cancer. _J. Clin. Oncol._ 21, 3737–3743 (2003). PubMed  Google Scholar  * Warwick, R. & Page, R. Resection of pulmonary metastases from colorectal carcinoma.

_Eur. J. Surg. Oncol._ 33 (Suppl. 2), S59–S63 (2007). PubMed  Google Scholar  * Winawer, S. J. _ et al_. Prevention of colorectal cancer by colonoscopic polypectomy. _N. Engl. J. Med._ 329,

1977–1981 (1993). CAS  PubMed  Google Scholar  * Bhangu, A. _ et al_. Meta-analysis of survival based on resection margin status following surgery for recurrent rectal cancer. _Colorectal

Dis._ 14, 1457–1466 (2012). CAS  PubMed  Google Scholar  * Chua, T. C. _ et al_. Hepatectomy and resection of concomitant extrahepatic disease for colorectal liver metastases — a systematic

review. _Eur. J. Cancer_ 48, 1757–1765 (2012). PubMed  Google Scholar  * Dresen, R. C. _ et al_. Radical resection after IORT-containing multimodality treatment is the most important

determinant for outcome in patients treated for locally recurrent rectal cancer. _Ann. Surg. Oncol._ 15, 1937–1947 (2008). PubMed  PubMed Central  Google Scholar  * Kanas, G. P. _ et al_.

Survival after liver resection in metastatic colorectal cancer: review and meta-analysis of prognostic factors. _Clin. Epidemiol._ 4, 283–301 (2012). PubMed  PubMed Central  Google Scholar 

* Rees, M. _ et al_. Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer: a multifactorial model of 929 patients. _Ann. Surg._ 247, 125–135 (2008).

PubMed  Google Scholar  * Cali, R. L. _ et al_. Cumulative incidence of metachronous colorectal cancer. _Dis. Colon Rectum_ 36, 388–393 (1993). CAS  PubMed  Google Scholar  * Green, R. J. _

et al_. Surveillance for second primary colorectal cancer after adjuvant chemotherapy: an analysis of Intergroup 0089. _Ann. Intern. Med._ 136, 261–269 (2002). CAS  PubMed  Google Scholar  *

Hohenberger, W. _ et al_. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation — technical notes and outcome. _Colorectal Dis._ 11, 354–364 (2009). CAS

  PubMed  Google Scholar  * Kapiteijn, E. _ et al_. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. _N. Engl. J. Med._ 345, 638–646 (2001).

CAS  PubMed  Google Scholar  * Mulder, S. A. _ et al_. The incidence and risk factors of metachronous colorectal cancer: an indication for follow-up. _Dis. Colon Rectum_ 55, 522–531 (2012).

PubMed  Google Scholar  * Obrand, D. I. & Gordon, P. H. Incidence and patterns of recurrence following curative resection for colorectal carcinoma. _Dis. Colon Rectum_ 40, 15–24 (1997).

CAS  PubMed  Google Scholar  * Peeters, K. C. _ et al_. The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with

resectable rectal carcinoma. _Ann. Surg._ 246, 693–701 (2007). PubMed  Google Scholar  * Ringland, C. L. _ et al_. Second primary colorectal cancers (SPCRCs): experiences from a large

Australian Cancer Registry. _Ann. Oncol._ 21, 92–97 (2010). CAS  PubMed  Google Scholar  * Pickhardt, P. J. _ et al_. Colorectal cancer: CT colonography and colonoscopy for detection —

systematic review and meta-analysis. _Radiology_ 259, 393–405 (2011). PubMed  PubMed Central  Google Scholar  * Labianca, R. _ et al_. Early colon cancer: ESMO Clinical Practice Guidelines

for diagnosis, treatment and follow-up. _Ann. Oncol._ 24 (Suppl. 6), vi64–vi72 (2013). PubMed  Google Scholar  * Meyerhardt, J. A. _ et al_. Follow-up care, surveillance protocol, and

secondary prevention measures for survivors of colorectal cancer: American Society of Clinical Oncology clinical practice guideline endorsement. _J. Clin. Oncol._ 31, 4465–4470 (2013).

PubMed  Google Scholar  * National Comprehensive Cancer Network. Guidelines for treatment of colorectal cancer. _NCCN_ https://www.nccn.org/professionals/physician_gls/f_guidelines.asp#site

(2016). * National Institute for Health and Care Excellence. Colorectal cancer: diagnosis and management. _NICE_ http://www.nice.org.uk/Guidance/CG131 (updated 2014). * Steele, S. R. _ et

al_. Practice guideline for the surveillance of patients after curative treatment of colon and rectal cancer. _Dis. Colon Rectum_ 58, 713–725 (2015). PubMed  Google Scholar  * Van Cutsem, E.

_ et al_. Metastatic colorectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. _Ann. Oncol._ 25 (Suppl. 3), iii1–iii9 (2014). PubMed  Google Scholar  *

Barillari, P. _ et al_. Surveillance of colorectal cancer: effectiveness of early detection of intraluminal recurrences on prognosis and survival of patients treated for cure. _Dis. Colon

Rectum_ 39, 388–393 (1996). CAS  PubMed  Google Scholar  * Chen, F. & Stuart, M. Colonoscopic follow-up of colorectal carcinoma. _Dis. Colon Rectum_ 37, 568–572 (1994). CAS  PubMed 

Google Scholar  * Granqvist, S. & Karlsson, T. Postoperative follow-up of patients with colorectal carcinoma by colonoscopy. _Eur. J. Surg._ 158, 307–312 (1992). CAS  PubMed  Google

Scholar  * Grobbee, E. J. _ et al_. Second-look colonoscopies and the impact on capacity in FIT-based colorectal cancer screening. _Am. J. Gastroenterol._ 110, 1072–1077 (2015). PubMed 

Google Scholar  * Juhl, G. _ et al_. Six-year results of annual colonoscopy after resection of colorectal cancer. _World J. Surg._ 14, 255–260 (1990). CAS  PubMed  Google Scholar  *

Kjeldsen, B. J. _ et al_. A prospective randomized study of follow-up after radical surgery for colorectal cancer. _Br. J. Surg._ 84, 666–669 (1997). CAS  PubMed  Google Scholar  *

Schoemaker, D. _ et al_. Yearly colonoscopy, liver CT, and chest radiography do not influence 5-year survival of colorectal cancer patients. _Gastroenterology_ 114, 7–14 (1998). CAS  PubMed

  Google Scholar  * Togashi, K. _ et al_. Predictive factors for detecting colorectal carcinomas in surveillance colonoscopy after colorectal cancer surgery. _Dis. Colon Rectum_ 43 (10

Suppl.), S47–S53 (2000). CAS  PubMed  Google Scholar  * Wang, T. _ et al_. The role of postoperative colonoscopic surveillance after radical surgery for colorectal cancer: a prospective,

randomized clinical study. _Gastrointest. Endosc._ 69, 609–615 (2009). PubMed  Google Scholar  * Robertson, D. J., Kaminski, M. F. & Bretthauer, M. Effectiveness, training and quality

assurance of colonoscopy screening for colorectal cancer. _Gut_ 64, 982–990 (2015). PubMed  Google Scholar  * Kim, H. J. _ et al_. CT colonography for combined colonic and extracolonic

surveillance after curative resection of colorectal cancer. _Radiology_ 257, 697–704 (2010). PubMed  Google Scholar  * Amitai, M. M. _ et al_. Contrast-enhanced CT colonography with 64-slice

MDCT compared to endoscopic colonoscopy in the follow-up of patients after colorectal cancer resection. _Clin. Imaging_ 33, 433–438 (2009). PubMed  Google Scholar  * Fletcher, J. G. _ et

al_. Contrast-enhanced CT colonography in recurrent colorectal carcinoma: feasibility of simultaneous evaluation for metastatic disease, local recurrence, and metachronous neoplasia in

colorectal carcinoma. _AJR Am. J. Roentgenol._ 178, 283–290 (2002). CAS  PubMed  Google Scholar  * Laghi, A. _ et al_. Contrast-enhanced computed tomographic colonography in the follow-up of

colorectal cancer patients: a feasibility study. _Eur. Radiol._ 13, 883–889 (2003). PubMed  Google Scholar  * Lee, J. H. _ et al_. CT colonography in patients who have undergone sigmoid

colostomy: a feasibility study. _AJR Am. J. Roentgenol._ 197, W653–W657 (2011). PubMed  Google Scholar  * Leonardou, P. _ et al_. Screening of patients after colectomy: virtual colonography.

_Abdom. Imaging_ 31, 521–528 (2006). CAS  PubMed  Google Scholar  * Neri, E. _ et al_. Post-surgical follow-up of colorectal cancer: role of contrast-enhanced CT colonography. _Abdom.

Imaging_ 35, 669–675 (2010). PubMed  Google Scholar  * You, Y. T. _ et al_. Evaluation of contrast-enhanced computed tomographic colonography in detection of local recurrent colorectal

cancer. _World J. Gastroenterol._ 12, 123–126 (2006). PubMed  PubMed Central  Google Scholar  * de Wijkerslooth, T. R. _ et al_. Burden of colonoscopy compared to non-cathartic

CT-colonography in a colorectal cancer screening programme: randomised controlled trial. _Gut_ 61, 1552–1559 (2012). PubMed  Google Scholar  * Dighe, S. _ et al_. Diagnostic precision of CT

in local staging of colon cancers: a meta-analysis. _Clin. Radiol._ 65, 708–719 (2010). CAS  PubMed  Google Scholar  * Kievit, J. Follow-up of patients with colorectal cancer: numbers needed

to test and treat. _Eur. J. Cancer_ 38, 986–999 (2002). CAS  PubMed  Google Scholar  * Blomqvist, L. _ et al_. MR imaging, CT and CEA scintigraphy in the diagnosis of local recurrence of

rectal carcinoma. _Acta Radiol._ 37, 779–784 (1996). CAS  PubMed  Google Scholar  * Pema, P. J. _ et al_. CT versus MRI diagnosis recurrent rectosigmoid carcinoma. _J. Comput. Assist.

Tomogr._ 18, 256–261 (1994). CAS  PubMed  Google Scholar  * Group, M. S. Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer:

prospective observational study. _BMJ_ 333, 779 (2006). Google Scholar  * Bipat, S. _ et al_. Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT,

and MR imaging — a meta-analysis. _Radiology_ 232, 773–783 (2004). PubMed  Google Scholar  * Titu, L. V. _ et al_. Routine follow-up by magnetic resonance imaging does not improve detection

of resectable local recurrences from colorectal cancer. _Ann. Surg._ 243, 348–352 (2006). PubMed  PubMed Central  Google Scholar  * Glynne-Jones, R. & Hughes, R. Critical appraisal of

the 'wait and see' approach in rectal cancer for clinical complete responders after chemoradiation. _Br. J. Surg._ 99, 897–909 (2012). CAS  PubMed  Google Scholar  * Glynne-Jones,

R. & Hughes, R. Complete response after chemoradiotherapy in rectal cancer (watch-and-wait): have we cracked the code? _Clin. Oncol. (R. Coll. Radiol.)_ 28, 152–160 (2016). CAS  Google

Scholar  * Furukawa, H. _ et al_. Positron emission tomography scanning is not superior to whole body multidetector helical computed tomography in the preoperative staging of colorectal

cancer. _Gut_ 55, 1007–1011 (2006). CAS  PubMed  PubMed Central  Google Scholar  * Shin, S. S. _ et al_. Preoperative staging of colorectal cancer: CT versus integrated FDG PET/CT. _Abdom.

Imaging_ 33, 270–277 (2008). PubMed  Google Scholar  * Tsunoda, Y. _ et al_. Preoperative diagnosis of lymph node metastases of colorectal cancer by FDG-PET/CT. _Jpn J. Clin. Oncol._ 38,

347–353 (2008). PubMed  Google Scholar  * Huebner, R. H. _ et al_. A meta-analysis of the literature for whole-body FDG PET detection of recurrent colorectal cancer. _J. Nucl. Med._ 41,

1177–1189 (2000). CAS  PubMed  Google Scholar  * Even-Sapir, E. _ et al_. Detection of recurrence in patients with rectal cancer: PET/CT after abdominoperineal or anterior resection.

_Radiology_ 232, 815–822 (2004). PubMed  Google Scholar  * Sobhani, I. _ et al_. Early detection of recurrence by 18FDG-PET in the follow-up of patients with colorectal cancer. _Br. J.

Cancer_ 98, 875–880 (2008). CAS  PubMed  PubMed Central  Google Scholar  * Khan, K. _ et al_. Survival outcomes in asymptomatic patients with normal conventional imaging but raised

carcinoembryonic antigen levels in colorectal cancer following positron emission tomography-computed tomography imaging. _Oncologist_ http://dx.doi.org/10.1634/theoncologist.2016-0222

(2016). * Fukunaga, H. _ et al_. Fusion image of positron emission tomography and computed tomography for the diagnosis of local recurrence of rectal cancer. _Ann. Surg. Oncol._ 12, 561–569

(2005). PubMed  Google Scholar  * Engenhart, R. _ et al_. Therapy monitoring of presacral recurrences after high-dose irradiation: value of PET, CT, CEA and pain score. _Strahlenther.

Onkol._ 168, 203–212 (1992). CAS  PubMed  Google Scholar  * Moore, H. G. _ et al_. A case-controlled study of 18-fluorodeoxyglucose positron emission tomography in the detection of pelvic

recurrence in previously irradiated rectal cancer patients. _J. Am. Coll. Surg._ 197, 22–28 (2003). PubMed  Google Scholar  * Elferink, M. A. _ et al_. Metachronous metastases from

colorectal cancer: a population-based study in North-East Netherlands. _Int. J. Colorectal Dis._ 30, 205–212 (2015). PubMed  Google Scholar  * Tan, E. _ et al_. Diagnostic precision of

carcinoembryonic antigen in the detection of recurrence of colorectal cancer. _Surg. Oncol._ 18, 15–24 (2009). PubMed  Google Scholar  * Staab, H. J. _ et al_. Slope analysis of the

postoperative CEA time course and its possible application as an aid in diagnosis of disease progression in gastrointestinal cancer. _Am. J. Surg._ 136, 322–327 (1978). CAS  PubMed  Google

Scholar  * Verberne, C. J. _ et al_. Detection of recurrences during follow-up after liver surgery for colorectal metastases: both carcinoembryonic antigen (CEA) and imaging are important.

_Ann. Surg. Oncol._ 20, 457–463 (2013). PubMed  Google Scholar  * Verberne, C. J. _ et al_. Intensified follow-up in colorectal cancer patients using frequent carcino-embryonic antigen (CEA)

measurements and CEA-triggered imaging: results of the randomized “CEAwatch” trial. _Eur. J. Surg. Oncol._ 41, 1188–1196 (2015). CAS  PubMed  Google Scholar  * Bipat, S. _ et al_.

Colorectal liver metastases: CT, MR imaging, and PET for diagnosis — meta-analysis. _Radiology_ 237, 123–131 (2005). PubMed  Google Scholar  * Kinkel, K. _ et al_. Detection of hepatic

metastases from cancers of the gastrointestinal tract by using noninvasive imaging methods (US, CT, MR imaging, PET): a meta-analysis. _Radiology_ 224, 748–756 (2002). PubMed  Google Scholar

  * Westwood, M. _ et al_. Contrast-enhanced ultrasound using SonoVue® (sulphur hexafluoride microbubbles) compared with contrast-enhanced computed tomography and contrast-enhanced magnetic

resonance imaging for the characterisation of focal liver lesions and detection of liver metastases: a systematic review and cost-effectiveness analysis. _Health Technol. Assess._ 17, 1–243

(2013). PubMed  PubMed Central  Google Scholar  * Mainenti, P. P. _ et al_. Non-invasive diagnostic imaging of colorectal liver metastases. _World J. Radiol._ 7, 157–169 (2015). PubMed 

PubMed Central  Google Scholar  * Niekel, M. C., Bipat, S. & Stoker, J. Diagnostic imaging of colorectal liver metastases with CT, MR imaging, FDG PET, and/or FDG PET/CT: a meta-analysis

of prospective studies including patients who have not previously undergone treatment. _Radiology_ 257, 674–684 (2010). PubMed  Google Scholar  * Patel, S. _ et al_. Positron emission

tomography/computed tomographic scans compared to computed tomographic scans for detecting colorectal liver metastases: a systematic review. _Ann. Surg._ 253, 666–671 (2011). PubMed  Google

Scholar  * Kronawitter, U. _ et al_. Evaluation of chest computed tomography in the staging of patients with potentially resectable liver metastases from colorectal carcinoma. _Cancer_ 86,

229–235 (1999). CAS  PubMed  Google Scholar  * Povoski, S. P. _ et al_. Role of chest CT in patients with negative chest X-rays referred for hepatic colorectal metastases. _Ann. Surg.

Oncol._ 5, 9–15 (1998). CAS  PubMed  Google Scholar  * Duffy, M. J. _ et al_. Use of faecal markers in screening for colorectal neoplasia: a European group on tumor markers position paper.

_Int. J. Cancer_ 128, 3–11 (2011). CAS  PubMed  Google Scholar  * Whitlock, E. P. _ et al_. Screening for colorectal cancer: a targeted, updated systematic review for the U.S. Preventive

Services Task Force. _Ann. Intern. Med._ 149, 638–658 (2008). PubMed  Google Scholar  * Jahn, H. _ et al_. Can Hemoccult-II replace colonoscopy in surveillance after radical surgery for

colorectal cancer and after polypectomy? _Dis. Colon Rectum_ 35, 253–256 (1992). CAS  PubMed  Google Scholar  * Imperiale, T. F. _ et al_. Multitarget stool DNA testing for colorectal-cancer

screening. _N. Engl. J. Med._ 370, 1287–1297 (2014). CAS  PubMed  Google Scholar  * Bosch, L. J. _ et al_. Molecular tests for colorectal cancer screening. _Clin. Colorectal Cancer_ 10,

8–23 (2011). CAS  PubMed  Google Scholar  * Lee, B. B. _ et al_. Aberrant methylation of _APC_, _MGMT_, _RASSF2A_, and _Wif-1_ genes in plasma as a biomarker for early detection of

colorectal cancer. _Clin. Cancer Res._ 15, 6185–6191 (2009). CAS  PubMed  Google Scholar  * Leung, W. K. _ et al_. Quantitative detection of promoter hypermethylation in multiple genes in

the serum of patients with colorectal cancer. _Am. J. Gastroenterol._ 100, 2274–2279 (2005). CAS  PubMed  Google Scholar  * Lalmahomed, Z. S. _ et al_. Circulating tumor cells and sample

size: the more, the better. _J. Clin. Oncol._ 28, e288–e289 (2010). PubMed  Google Scholar  * Mostert, B. _ et al_. _KRAS_ and _BRAF_ mutation status in circulating colorectal tumor cells

and their correlation with primary and metastatic tumor tissue. _Int. J. Cancer_ 133, 130–141 (2013). CAS  PubMed  Google Scholar  * Mostert, B. _ et al_. mRNA expression profiles in

circulating tumor cells of metastatic colorectal cancer patients. _Mol. Oncol._ 9, 920–932 (2015). CAS  PubMed  PubMed Central  Google Scholar  * Best, M. G. _ et al_. RNA-Seq of

tumor-educated platelets enables blood-based pan-cancer, multiclass, and molecular pathway cancer diagnostics. _Cancer Cell_ 28, 666–676 (2015). CAS  PubMed  PubMed Central  Google Scholar 

* Nilsson, R. J. _ et al_. Blood platelets contain tumor-derived RNA biomarkers. _Blood_ 118, 3680–3683 (2011). PubMed  PubMed Central  Google Scholar  * Metzger, J. _ et al_. Urine

proteomic analysis differentiates cholangiocarcinoma from primary sclerosing cholangitis and other benign biliary disorders. _Gut_ 62, 122–130 (2013). CAS  PubMed  Google Scholar  * Broker,

M. E. _ et al_. Collagen peptides in urine: a new promising biomarker for the detection of colorectal liver metastases. _PLoS ONE_ 8, e70918 (2013). PubMed  PubMed Central  Google Scholar  *

Deslauriers, J. & Gregoire, J. Clinical and surgical staging of non-small cell lung cancer. _Chest_ 117 (4 Suppl. 1), 96S–103S (2000). CAS  PubMed  Google Scholar  * Staples, C. A. _ et

al_. Mediastinal nodes in bronchogenic carcinoma: comparison between CT and mediastinoscopy. _Radiology_ 167, 367–372 (1988). CAS  PubMed  Google Scholar  * Antoch, G. _ et al_. Whole-body

dual-modality PET/CT and whole-body MRI for tumor staging in oncology. _JAMA_ 290, 3199–3206 (2003). CAS  PubMed  Google Scholar  * Antoch, G. & Bockisch, A. Combined PET/MRI: a new

dimension in whole-body oncology imaging? _Eur. J. Nucl. Med. Mol. Imaging_ 36 (Suppl. 1), S113–S120 (2009). PubMed  Google Scholar  * Pfannenberg, C. _ et al_. Prospective comparison of

18F-fluorodeoxyglucose positron emission tomography/computed tomography and whole-body magnetic resonance imaging in staging of advanced malignant melanoma. _Eur. J. Cancer_ 43, 557–564

(2007). PubMed  Google Scholar  * Schmidt, G. P. _ et al_. Comprehensive imaging of tumor recurrence in breast cancer patients using whole-body MRI at 1.5 and 3 T compared to FDG-PET-CT.

_Eur. J. Radiol._ 65, 47–58 (2008). PubMed  Google Scholar  * Squillaci, E. _ et al_. Staging of colon cancer: whole-body MRI versus whole-body PET-CT — initial clinical experience. _Abdom.

Imaging_ 33, 676–688 (2008). PubMed  Google Scholar  * Sargent, D. J. _ et al_. End points for colon cancer adjuvant trials: observations and recommendations based on individual patient data

from 20,898 patients enrolled onto 18 randomized trials from the ACCENT Group. _J. Clin. Oncol._ 25, 4569–4574 (2007). PubMed  Google Scholar  * Tomlinson, J. S. _ et al_. Actual 10-year

survival after resection of colorectal liver metastases defines cure. _J. Clin. Oncol._ 25, 4575–4580 (2007). PubMed  Google Scholar  * Walter, C. J. _ et al_. Fifth-year surveillance

computed tomography scanning after potentially curative resections for colorectal cancer. _Surgeon_ 11, 25–29 (2013). PubMed  Google Scholar  * Augestad, K. M. _ et al_. Cost-effectiveness

and quality of life in surgeon versus general practitioner-organised colon cancer surveillance: a randomised controlled trial. _BMJ Open_ 3, e002391 (2013). PubMed  PubMed Central  Google

Scholar  * Grossmann, E. M. _ et al_. Follow-up of colorectal cancer patients after resection with curative intent-the GILDA trial. _Surg. Oncol._ 13, 119–124 (2004). PubMed  Google Scholar

  * Mäkelä, J. T., Laitinen, S. O. & Kairaluoma, M. I. Five-year follow-up after radical surgery for colorectal cancer. Results of a prospective randomized trial. _Arch. Surg._ 130,

1062–1067 (1995). PubMed  Google Scholar  * Ohlsson, B. _ et al_. Follow-up after curative surgery for colorectal carcinoma. Randomized comparison with no follow-up. _Dis. Colon Rectum_ 38,

619–626 (1995). CAS  PubMed  Google Scholar  * Pietra, N. _ et al_. Role of follow-up in management of local recurrences of colorectal cancer: a prospective, randomized study. _Dis. Colon

Rectum_ 41, 1127–1133 (1998). CAS  PubMed  Google Scholar  * Primrose, J. N. _ et al_. Effect of 3 to 5 years of scheduled CEA and CT follow-up to detect recurrence of colorectal cancer: the

FACS randomized clinical trial. _JAMA_ 311, 263–270 (2014). CAS  PubMed  Google Scholar  * Rodriguez-Moranta, F. _ et al_. Postoperative surveillance in patients with colorectal cancer who

have undergone curative resection: a prospective, multicenter, randomized, controlled trial. _J. Clin. Oncol._ 24, 386–393 (2006). PubMed  Google Scholar  * Rosati, G. _ et al_. A randomized

trial of intensive versus minimal surveillance patients with resected Dukes B2-C colorectal carcinoma. _Ann. Oncol._ 27, 274–280 (2016). CAS  PubMed  Google Scholar  * Secco, G. B. _ et

al_. Efficacy and cost of risk-adapted follow-up in patients after colorectal cancer surgery: a prospective, randomized and controlled trial. _Eur. J. Surg. Oncol._ 28, 418–423 (2002).

PubMed  Google Scholar  * Treasure, T. _ et al_. The CEA Second-Look Trial: a randomised controlled trial of carcinoembryonic antigen prompted reoperation for recurrent colorectal cancer.

_BMJ Open_ 4, e004385 (2014). PubMed  PubMed Central  Google Scholar  * Wattchow, D. A. _ et al_. General practice versus surgical-based follow-up for patients with colon cancer: randomised

controlled trial. _Br. J. Cancer_ 94, 1116–1121 (2006). CAS  PubMed  PubMed Central  Google Scholar  * Wille-Jorgensen, P. _ et al_. An interim analysis of recruitment to the COLOFOL trial.

_Colorectal Dis._ 11, 756–758 (2009). CAS  PubMed  Google Scholar  * Pugh, S. A. M. _ et al_. Scheduled use of CEA and CT follow-up to detect recurrence of colorectal cancer: 6–12 year

results from the FACS randomised controlled trial [abstract]. _Ann. Oncol._ 27 (Suppl. 6), 453O (2016). Google Scholar  * Figueredo, A. _ et al_. Follow-up of patients with curatively

resected colorectal cancer: a practice guideline. _BMC Cancer_ 3, 26 (2003). PubMed  PubMed Central  Google Scholar  * Jeffery, M., Hickey, B. E. & Hider, P. N. Follow-up strategies for

patients treated for non-metastatic colorectal cancer. _Cochrane Database Syst. Rev._ 1, CD002200 (2007). Google Scholar  * Renehan, A. G. _ et al_. Impact on survival of intensive follow up

after curative resection for colorectal cancer: systematic review and meta-analysis of randomised trials. _BMJ_ 324, 813 (2002). PubMed  PubMed Central  Google Scholar  * Renehan, A. G. _

et al_. Mechanisms of improved survival from intensive followup in colorectal cancer: a hypothesis. _Br. J. Cancer_ 92, 430–433 (2005). CAS  PubMed  PubMed Central  Google Scholar  *

Tjandra, J. J. & Chan, M. K. Follow-up after curative resection of colorectal cancer: a meta-analysis. _Dis. Colon Rectum_ 50, 1783–1799 (2007). PubMed  Google Scholar  * Mokhles, S. _

et al_. Meta-analysis of colorectal cancer follow-up after potentially curative resection. _Br. J. Surg._ 103, 1259–1268 (2016). CAS  PubMed  PubMed Central  Google Scholar  * Kuchler, T. _

et al_. Impact of psychotherapeutic support on gastrointestinal cancer patients undergoing surgery: survival results of a trial. _Hepatogastroenterology_ 46, 322–335 (1999). CAS  PubMed 

Google Scholar  * Newell, S. A., Sanson-Fisher, R. W. & Savolainen, N. J. Systematic review of psychological therapies for cancer patients: overview and recommendations for future

research. _J. Natl Cancer Inst._ 94, 558–584 (2002). PubMed  Google Scholar  * Braunholtz, D. A., Edwards, S. J. & Lilford, R. J. Are randomized clinical trials good for us (in the short

term)? Evidence for a “trial effect”. _J. Clin. Epidemiol._ 54, 217–224 (2001). CAS  PubMed  Google Scholar  * Calle, E. E. _ et al_. Overweight, obesity, and mortality from cancer in a

prospectively studied cohort of U.S. adults. _N. Engl. J. Med._ 348, 1625–1638 (2003). PubMed  Google Scholar  * Kjeldsen, B. J. _ et al_. Influence of follow-up on health-related quality of

life after radical surgery for colorectal cancer. _Scand. J. Gastroenterol._ 34, 509–515 (1999). CAS  PubMed  Google Scholar  * Bhangu, A. _ et al_. Survival outcome of local excision

versus radical resection of colon or rectal carcinoma: a Surveillance, Epidemiology, and End Results (SEER) population-based study. _Ann. Surg._ 258, 563–569 (2013). PubMed  Google Scholar 

* Verseveld, M. _ et al_. Chemoradiation therapy for rectal cancer in the distal rectum followed by organ-sparing transanal endoscopic microsurgery (CARTS study). _Br. J. Surg._ 102, 853–860

(2015). CAS  PubMed  Google Scholar  * Schlemper, R. J. _ et al_. The Vienna classification of gastrointestinal epithelial neoplasia. _Gut_ 47, 251–255 (2000). CAS  PubMed  PubMed Central 

Google Scholar  * Meining, A. _ et al_. Risk factors for unfavorable outcomes after endoscopic removal of submucosal invasive colorectal tumors. _Clin. Gastroenterol. Hepatol._ 9, 590–594

(2011). PubMed  Google Scholar  * Morson, B. C. _ et al_. Histopathology and prognosis of malignant colorectal polyps treated by endoscopic polypectomy. _Gut_ 25, 437–444 (1984). CAS  PubMed

  PubMed Central  Google Scholar  * Muller, S. _ et al_. Significance of venous and lymphatic invasion in malignant polyps of the colon and rectum. _Gut_ 30, 1385–1391 (1989). CAS  PubMed 

PubMed Central  Google Scholar  * Nascimbeni, R. _ et al_. Risk of lymph node metastasis in T1 carcinoma of the colon and rectum. _Dis. Colon Rectum_ 45, 200–206 (2002). PubMed  Google

Scholar  * Bach, S. P. _ et al_. A predictive model for local recurrence after transanal endoscopic microsurgery for rectal cancer. _Br. J. Surg._ 96, 280–290 (2009). CAS  PubMed  Google

Scholar  * Davila, R. E. _ et al_. ASGE guideline: the role of endoscopy in the diagnosis, staging, and management of colorectal cancer. _Gastrointest. Endosc._ 61, 1–7 (2005). PubMed 

Google Scholar  * Hassan, C. _ et al_. Histologic risk factors and clinical outcome in colorectal malignant polyp: a pooled-data analysis. _Dis. Colon Rectum_ 48, 1588–1596 (2005). PubMed 

Google Scholar  * Buchner, A. M., Guarner-Argente, C. & Ginsberg, G. G. Outcomes of EMR of defiant colorectal lesions directed to an endoscopy referral center. _Gastrointest. Endosc._

76, 255–263 (2012). PubMed  Google Scholar  * Khashab, M. _ et al_. Incidence and predictors of “late” recurrences after endoscopic piecemeal resection of large sessile adenomas.

_Gastrointest. Endosc._ 70, 344–349 (2009). PubMed  Google Scholar  * Lieberman, D. A. _ et al_. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update

by the US Multi-Society Task Force on Colorectal Cancer. _Gastroenterology_ 143, 844–857 (2012). PubMed  Google Scholar  * Winawer, S. J. _ et al_. Guidelines for colonoscopy surveillance

after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. _Gastroenterology_ 130, 1872–1885 (2006). PubMed  Google

Scholar  * Zlatanic, J. _ et al_. Large sessile colonic adenomas: use of argon plasma coagulator to supplement piecemeal snare polypectomy. _Gastrointest. Endosc._ 49, 731–735 (1999). CAS 

PubMed  Google Scholar  * Di Gregorio, C. _ et al_. Clinical outcome of low- and high-risk malignant colorectal polyps: results of a population-based study and meta-analysis of the available

literature. _Intern. Emerg. Med._ 9, 151–160 (2014). PubMed  Google Scholar  * Kim, M. N. _ et al_. Clinical features and prognosis of early colorectal cancer treated by endoscopic mucosal

resection. _J. Gastroenterol. Hepatol._ 26, 1619–1625 (2011). PubMed  Google Scholar  * Ackland, S. P. _ et al_. A meta-analysis of two randomised trials of early chemotherapy in

asymptomatic metastatic colorectal cancer. _Br. J. Cancer_ 93, 1236–1243 (2005). CAS  PubMed  PubMed Central  Google Scholar  * Cairns, S. R. _ et al_. Guidelines for colorectal cancer

screening and surveillance in moderate and high risk groups (update from 2002). _Gut_ 59, 666–689 (2010). PubMed  Google Scholar  * Hartley, A. _ et al_. Pathological complete response

following pre-operative chemoradiotherapy in rectal cancer: analysis of phase II/III trials. _Br. J. Radiol._ 78, 934–938 (2005). CAS  PubMed  Google Scholar  * Habr-Gama, A. _ et al_. Watch

and wait approach following extended neoadjuvant chemoradiation for distal rectal cancer: are we getting closer to anal cancer management? _Dis. Colon Rectum_ 56, 1109–1117 (2013). PubMed 

Google Scholar  * Maas, M. _ et al_. Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data.

_Lancet Oncol._ 11, 835–844 (2010). PubMed  Google Scholar  * Hiotis, S. P. _ et al_. Assessing the predictive value of clinical complete response to neoadjuvant therapy for rectal cancer:

an analysis of 488 patients. _J. Am. Coll. Surg._ 194, 131–135 (2002). PubMed  Google Scholar  * Zmora, O. _ et al_. Does rectal wall tumor eradication with preoperative chemoradiation

permit a change in the operative strategy? _Dis. Colon Rectum_ 47, 1607–1612 (2004). PubMed  Google Scholar  * Pucciarelli, S. _ et al_. Relationship between pathologic T-stage and nodal

metastasis after preoperative chemoradiotherapy for locally advanced rectal cancer. _Ann. Surg. Oncol._ 12, 111–116 (2005). PubMed  Google Scholar  * Maas, M. _ et al_. Assessment of

clinical complete response after chemoradiation for rectal cancer with digital rectal examination, endoscopy, and MRI: selection for organ-saving treatment. _Ann. Surg. Oncol._ 22, 3873–3880

(2015). PubMed  PubMed Central  Google Scholar  * Araujo, R. O. _ et al_. Nonoperative management of rectal cancer after chemoradiation opposed to resection after complete clinical

response. A comparative study. _Eur. J. Surg. Oncol._ 41, 1456–1463 (2015). CAS  PubMed  Google Scholar  * Dalton, R. S. _ et al_. A single-centre experience of chemoradiotherapy for rectal

cancer: is there potential for nonoperative management? _Colorectal Dis._ 14, 567–571 (2012). CAS  PubMed  Google Scholar  * Habr-Gama, A. Assessment and management of the complete clinical

response of rectal cancer to chemoradiotherapy. _Colorectal Dis._ 8 (Suppl. 3), 21–24 (2006). PubMed  Google Scholar  * Maas, M. _ et al_. Wait-and-see policy for clinical complete

responders after chemoradiation for rectal cancer. _J. Clin. Oncol._ 29, 4633–4640 (2011). PubMed  Google Scholar  * Smith, J. D. _ et al_. Nonoperative management of rectal cancer with

complete clinical response after neoadjuvant therapy. _Ann. Surg._ 256, 965–972 (2012). PubMed  Google Scholar  * Yeo, S. G., Kim, D. Y. & Oh, J. H. Long-term survival without surgery

following a complete response to pre-operative chemoradiotherapy for rectal cancer: a case series. _Oncol. Lett._ 6, 1573–1576 (2013). PubMed  PubMed Central  Google Scholar  * Yu, S. K. _

et al_. Deferral of rectal surgery following a continued response to preoperative chemoradiotherapy (Watch and Wait) study: a phase II multicenter study in the United Kingdom [abstract]. _J.

Clin. Oncol._ 29, 489 (2011). Google Scholar  * US National Library of Medicine. _ClinicalTrials.gov_https://clinicaltrials.gov/ct2/show/NCT00939666 (2011). * Martens, M. H. _ et al_.

Long-term outcome of an organ preservation program after neoadjuvant treatment for rectal cancer. _J. Natl Cancer Inst._ 108, djw171 (2016). PubMed  Google Scholar  * de Ridder, J. A. _ et

al_. Management of liver metastases in colorectal cancer patients: a retrospective case–control study of systemic therapy versus liver resection. _Eur. J. Cancer_ 59, 13–21 (2016). PubMed 

Google Scholar  * Heinemann, V. _ et al_. FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer (FIRE-3): a

randomised, open-label, phase 3 trial. _Lancet Oncol._ 15, 1065–1075 (2014). CAS  PubMed  Google Scholar  * Loupakis, F. _ et al_. Initial therapy with FOLFOXIRI and bevacizumab for

metastatic colorectal cancer. _N. Engl. J. Med._ 371, 1609–1618 (2014). PubMed  Google Scholar  * van der Geest, L. G. _ et al_. Nationwide trends in incidence, treatment and survival of

colorectal cancer patients with synchronous metastases. _Clin. Exp. Metastasis_ 32, 457–465 (2015). CAS  PubMed  Google Scholar  * Ayez, N. _ et al_. Long-term results of the “liver first”

approach in patients with locally advanced rectal cancer and synchronous liver metastases. _Dis. Colon Rectum_ 56, 281–287 (2013). PubMed  Google Scholar  * House, M. G. _ et al_. Survival

after hepatic resection for metastatic colorectal cancer: trends in outcomes for 1,600 patients during two decades at a single institution. _J. Am. Coll. Surg._ 210, 744–752 (2010). PubMed 

Google Scholar  * van der Pool, A. E. _ et al_. Optimizing the outcome of surgery in patients with rectal cancer and synchronous liver metastases. _Br. J. Surg._ 97, 383–390 (2010). CAS 

PubMed  Google Scholar  * Chua, T. C. _ et al_. Predictors of cure after hepatic resection of colorectal liver metastases: an analysis of actual 5- and 10-year survivors. _J. Surg. Oncol._

103, 796–800 (2011). PubMed  Google Scholar  * Vigano, L. _ et al_. Liver surgery for colorectal metastases: results after 10 years of follow-up. Long-term survivors, late recurrences, and

prognostic role of morbidity. _Ann. Surg. Oncol._ 15, 2458–2464 (2008). PubMed  Google Scholar  * Gonzalez, M. _ et al_. Risk factors for survival after lung metastasectomy in colorectal

cancer patients: a systematic review and meta-analysis. _Ann. Surg. Oncol._ 20, 572–579 (2013). PubMed  Google Scholar  * Zampino, M. G. _ et al_. Lung metastases from colorectal cancer:

analysis of prognostic factors in a single institution study. _Ann. Thorac. Surg._ 98, 1238–1245 (2014). PubMed  Google Scholar  * Migliore, M. _ et al_. Finding the evidence for pulmonary

metastasectomy in colorectal cancer: the PulMicc trial. _Future Oncol._ 11 (Suppl. 2), 15–18 (2015). CAS  PubMed  Google Scholar  * Treasure, T. & Macbeth, F. The GILDA trial finds no

survival benefit from intensified screening after primary resection of colorectal cancer: the PulMiCC trial tests the survival benefit of pulmonary metastasectomy for detected asymptomatic

lung metastases. _Ann. Oncol._ 27, 745 (2016). CAS  PubMed  Google Scholar  * de Cuba, E. M. _ et al_. Cytoreductive surgery and HIPEC for peritoneal metastases combined with curative

treatment of colorectal liver metastases: systematic review of all literature and meta-analysis of observational studies. _Cancer Treat. Rev._ 39, 321–327 (2013). CAS  PubMed  Google Scholar

  * Elias, D., Quenet, F. & Goere, D. Current status and future directions in the treatment of peritoneal dissemination from colorectal carcinoma. _Surg. Oncol. Clin. N. Am._ 21, 611–623

(2012). PubMed  Google Scholar  * Esquivel, J. _ et al_. The American Society of Peritoneal Surface Malignancies (ASPSM) multiinstitution evaluation of the Peritoneal Surface Disease

Severity Score (PSDSS) in 1,013 patients with colorectal cancer with peritoneal carcinomatosis. _Ann. Surg. Oncol._ 21, 4195–4201 (2014). PubMed  Google Scholar  * Leung, U. _ et al_.

Colorectal cancer liver metastases and concurrent extrahepatic disease treated with resection. _Ann. Surg._ http://dx.doi.org/10.1097/SLA.0000000000001624 (2016). * US National Library of

Medicine. _ClinicalTrials.gov_https://clinicaltrials.gov/ct2/show/NCT01792934 (2015). * Sotiropoulos, G. C. & Lang, H. Clinical scoring systems for predicting outcome after surgery for

colorectal liver metastases: towards a better multidisciplinary approach. _Liver Int._ 29, 6–9 (2009). PubMed  Google Scholar  * Adam, R. _ et al_. Repeat hepatectomy for colorectal liver

metastases. _Ann. Surg._ 225, 51–60 (1997). CAS  PubMed  PubMed Central  Google Scholar  * Butte, J. M. _ et al_. Recurrence after partial hepatectomy for metastatic colorectal cancer:

potentially curative role of salvage repeat resection. _Ann. Surg. Oncol._ 22, 2761–2771 (2015). PubMed  PubMed Central  Google Scholar  * de Jong, M. C. _ et al_. Repeat curative intent

liver surgery is safe and effective for recurrent colorectal liver metastasis: results from an international multi-institutional analysis. _J. Gastrointest. Surg._ 13, 2141–2151 (2009).

PubMed  Google Scholar  * Lam, V. W. _ et al_. A systematic review of repeat hepatectomy for recurrent colorectal liver metastases. _J. Gastrointest. Surg._ 17, 1312–1321 (2013). PubMed 

Google Scholar  * van der Pool, A. E. _ et al_. Local treatment for recurrent colorectal hepatic metastases after partial hepatectomy. _J. Gastrointest. Surg._ 13, 890–895 (2009). PubMed 

Google Scholar  * Chen, F. _ et al_. Repeat resection of pulmonary metastasis is beneficial for patients with colorectal carcinoma. _World J. Surg._ 34, 2373–2378 (2010). PubMed  Google

Scholar  * Bhattacharjya, S., Aggarwal, R. & Davidson, B. R. Intensive follow-up after liver resection for colorectal liver metastases: results of combined serial tumour marker

estimations and computed tomography of the chest and abdomen — a prospective study. _Br. J. Cancer_ 95, 21–26 (2006). CAS  PubMed  PubMed Central  Google Scholar  * Connor, S. _ et al_.

Follow-up and outcomes for resection of colorectal liver metastases in Edinburgh. _Eur. J. Surg. Oncol._ 33, 55–60 (2007). CAS  PubMed  Google Scholar  * Gomez, D. _ et al_. Outcomes of

intensive surveillance after resection of hepatic colorectal metastases. _Br. J. Surg._ 97, 1552–1560 (2010). CAS  PubMed  Google Scholar  * Langenhoff, B. S., Krabbe, P. F. & Ruers, T.

J. Efficacy of follow-up after surgical treatment of colorectal liver metastases. _Eur. J. Surg. Oncol._ 35, 180–186 (2009). CAS  PubMed  Google Scholar  * Metcalfe, M. _ et al_. Detecting

curable disease following hepatectomy for colorectal metastases. _ANZ J. Surg._ 75, 524–527 (2005). PubMed  Google Scholar  * Metcalfe, M. S., Mullin, E. J. & Maddern, G. J. Choice of

surveillance after hepatectomy for colorectal metastases. _Arch. Surg._ 139, 749–754 (2004). PubMed  Google Scholar  * Wilhelmsen, M. _ et al_. Determinants of recurrence after intended

curative resection for colorectal cancer. _Scand. J. Gastroenterol._ 49, 1399–1408 (2014). PubMed  Google Scholar  * Belt, E. J. _ et al_. Peri-operative bowel perforation in early stage

colon cancer is associated with an adverse oncological outcome. _J. Gastrointest. Surg._ 16, 2260–2266 (2012). CAS  PubMed  Google Scholar  * Honore, C. _ et al_. Definition of patients

presenting a high risk of developing peritoneal carcinomatosis after curative surgery for colorectal cancer: a systematic review. _Ann. Surg. Oncol._ 20, 183–192 (2013). PubMed  Google

Scholar  * Cortet, M. _ et al_. Patterns of recurrence of obstructing colon cancers after surgery for cure: a population-based study. _Colorectal Dis._ 15, 1100–1106 (2013). CAS  PubMed 

Google Scholar  * Krarup, P. M. _ et al_. Anastomotic leak increases distant recurrence and long-term mortality after curative resection for colonic cancer: a nationwide cohort study. _Ann.

Surg._ 259, 930–938 (2014). PubMed  Google Scholar  * Busch, O. R. _ et al_. Blood transfusions and prognosis in colorectal cancer. _N. Engl. J. Med._ 328, 1372–1376 (1993). CAS  PubMed 

Google Scholar  * Elias, D. _ et al_. Results of systematic second-look surgery in patients at high risk of developing colorectal peritoneal carcinomatosis. _Ann. Surg._ 247, 445–450 (2008).

PubMed  Google Scholar  * Elias, D. _ et al_. Results of systematic second-look surgery plus HIPEC in asymptomatic patients presenting a high risk of developing colorectal peritoneal

carcinomatosis. _Ann. Surg._ 254, 289–293 (2011). CAS  PubMed  Google Scholar  * Ripley, R. T. _ et al_. Prospective randomized trial evaluating mandatory second look surgery with HIPEC and

CRS versus standard of care in patients at high risk of developing colorectal peritoneal metastases. 11, 62 (2010). * US National Library of Medicine.

_ClinicalTrials.gov_https://clinicaltrials.gov/ct2/show/NCT00005944 (2011). * de Wijkerslooth, T. R. _ et al_. Immunochemical fecal occult blood testing is equally sensitive for proximal and

distal advanced neoplasia. _Am. J. Gastroenterol._ 107, 1570–1578 (2012). CAS  PubMed  Google Scholar  * Edelman, B. R. & Weiser, M. R. Endorectal ultrasound: its role in the diagnosis

and treatment of rectal cancer. _Clin. Colon Rectal Surg._ 21, 167–177 (2008). PubMed  PubMed Central  Google Scholar  Download references AUTHOR INFORMATION AUTHORS AND AFFILIATIONS *

Department of Surgical Oncology, Erasmus MC University Medical Center. Erasmus MC Cancer Institute, Groene Hilledijk 301, Rotterdam, 3075 EA, Netherlands Eric P. van der Stok, Dirk J.

Grünhagen & Cornelis Verhoef * Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, s-Gravendijkwal 230, Rotterdam, 3015 CE, Netherlands Manon C. W.

Spaander & Ernst J. Kuipers Authors * Eric P. van der Stok View author publications You can also search for this author inPubMed Google Scholar * Manon C. W. Spaander View author

publications You can also search for this author inPubMed Google Scholar * Dirk J. Grünhagen View author publications You can also search for this author inPubMed Google Scholar * Cornelis

Verhoef View author publications You can also search for this author inPubMed Google Scholar * Ernst J. Kuipers View author publications You can also search for this author inPubMed Google

Scholar CONTRIBUTIONS E.P.v.d.S., C.V. and E.J.K. researched the data for article. All authors contributed substantially to discussions of content. E.P.v.d.S., C.V. and E.J.K. wrote the

manuscript. M.C.W.S., D.J.G., C.V., and E.J.K. reviewed/edited the manuscript before submission. CORRESPONDING AUTHOR Correspondence to Ernst J. Kuipers. ETHICS DECLARATIONS COMPETING

INTERESTS The authors declare no competing financial interests. SUPPLEMENTARY INFORMATION SUPPLEMENTARY INFORMATION S1 (TABLE) Randomized trials comparing different disease postoperative

surveillance strategies in patients with stage I–III CRC (DOC 128 kb) POWERPOINT SLIDES POWERPOINT SLIDE FOR FIG. 1 POWERPOINT SLIDE FOR FIG. 2 POWERPOINT SLIDE FOR FIG. 3 POWERPOINT SLIDE

FOR TABLE 1 POWERPOINT SLIDE FOR TABLE 2 POWERPOINT SLIDE FOR TABLE 3 POWERPOINT SLIDE FOR TABLE 4 POWERPOINT SLIDE FOR TABLE 5 POWERPOINT SLIDE FOR TABLE 6 POWERPOINT SLIDE FOR TABLE 7

RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE van der Stok, E., Spaander, M., Grünhagen, D. _et al._ Surveillance after curative treatment for

colorectal cancer. _Nat Rev Clin Oncol_ 14, 297–315 (2017). https://doi.org/10.1038/nrclinonc.2016.199 Download citation * Published: 20 December 2016 * Issue Date: May 2017 * DOI:

https://doi.org/10.1038/nrclinonc.2016.199 SHARE THIS ARTICLE Anyone you share the following link with will be able to read this content: Get shareable link Sorry, a shareable link is not

currently available for this article. Copy to clipboard Provided by the Springer Nature SharedIt content-sharing initiative