Definition and Overview
A follow-up is a part of a long-term care plan for patients who have undergone colorectal surgery, which is used either alone or in combination with other treatment methods such as chemo or radiation therapy (in cases that involve colorectal cancer.) Patients are strongly advised to show up for their follow-up appointments regardless if the surgery was a success or has failed to adequately address the problem. The goals of these visits are to check for signs of a recurrence and monitor the development of complications so prompt treatment can be provided.
The patient’s attending physician will prepare a follow-up care plan that outlines the number of required visits and their schedule. Each visit involves a review of the patient’s current condition as well as regular physical examinations.
Who Should Undergo and Expected Results
This type of follow-up is beneficial for all patients who have undergone colorectal surgical procedures, such as:
Local resection – This refers to an operation used to remove small, early stage cancerous tumors in the bowel or rectum.
Colectomy – Also known as a colon resection, this refers to the removal of a part of the colon that contains the tumor. In some cases, the lymph nodes closest to the bowel area are also removed.
Colostomy – A procedure wherein a hole is made in the abdominal wall for one end of the colon to pass through. This can be either temporary or permanent.
Hemorrhoidectomy – This is a minor outpatient procedure that removes hemorrhoids as well as prolapses with minimal risk of recurrence.
Trans anal endoscopic microsurgery – This removes a cancerous tumor from the rectal walls using an endoscope, a flexible tube with an attached camera and light source.
Total mesorectal excision – This is a rectal cancer surgery that removes the cancerous tumor, a border of healthy tissue around it and the mesorectum. This becomes necessary if it is suspected or found that the cancer cells have already spread to the mesorectum.
Sphincterotomy – This is used to treat anal fissures that fail to resolve on their own or with the help of non-surgical methods.
Rectopexy – This surgical procedure can treat rectal prolapse by repositioning the affected structures and securing them in place. This is, however, only used for severe cases that can no longer be remedied or improved by other treatment options.
All patients who undergo surgery will require follow-up appointments, regardless of whether they undergo traditional or keyhole surgery.
The primary goal of follow-ups is to detect recurrences early so that treatment can begin promptly. Patients should keep their appointments regardless of how they are feeling and whether they are experiencing symptoms or not.
The secondary goal is to help the patient manage or cope with the long-term side effects of the disease or the treatment as well as to watch out for late effects.
How Does the Procedure Work
The most important follow-up appointments are those scheduled during the first five years following treatment as this is the period when recurrences are most likely to occur. Thus, doctors meet with their patients every few months (once every 3-4 months) during the first five years, then once a year after that.
Follow-ups are more important for serious conditions such as cancer, as compared with less serious colorectal problems such as anal fissures or hemorrhoids. The possibility of cancer returning, however, is based on several factors. The schedule of appointments is thus also affected by the patient’s individual risk of recurrence.
In order to make an accurate assessment of the patient’s condition, physicians typically conduct some examinations during each follow-up visits. These tests include:
- Physical examination
- Blood tests
- Carcinoembryonic antigen tests – These are scheduled every three to six months for five years or even longer
- CT scan – This is performed every six to twelve months for the first three years if the patient has a high risk of recurrence. These can be either abdominal, chest, or rectal scans. On the 4th and 5th years, only a pelvic CT scan is required.
- Liver ultrasound scan
- Colonoscopy – This is often performed one year after colorectal surgery
- Rectosigmoidoscopy – This is performed once every six months for five years especially if the patient did not receive radiation therapy.
These tests may be scheduled differently and are usually not performed on the same day or in every session, except for the routine physical exam and blood test.
Possible Risks and Complications
A colorectal surgery follow-up appointment may involve some tests, some of which carry certain risks, which mainly involve perforation (or the development of a tear in the rectal passage or rectal wall) and bleeding from the rectum. However, these are rare and can also be treated by the same doctor performing the tests. Despite these risks, patients are advised to push through with their long-term follow-up care plan, as the risk of recurrence and its possible consequences are greater than the risk of undergoing the said exams.
In addition, surgery itself puts the patient at risk of:
- Blood loss
- Blood clot
These are often detected and managed during the first few follow-up visits after the surgery. Doctors will most likely prescribe pain medications and antibiotics to patients post-surgery, and the use of these medications may require constant monitoring, making follow-ups more important.
Burt RW, Barthel JS, Dunn KB, et al. NCCN clinical practice guidelines in oncology. Colorectal cancer screening. J Natl Compr Canc Netw. 2010 Jan;8(1):8-61.
Engstrom PF, Arnoletti JP, Benson AB 3rd, et al. NCCN Clinical Practice Guidelines in Oncology: colon cancer. J Natl Compr Canc Netw. 2009 Sep;7(8):778-831.