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In order to evaluate the effectiveness of follow-up in detecting potentially curable recurrences after radical surgery for colorectal cancer, we compared the results in 368 patients undergoing regular follow-up with those in 139 patients outside the follow-up program. The cancer-related 5-year survival rate was 72% in the follow-up group and 62% in the non-follow-up group (difference not significant). Cancer recurrences were more common in the follow-up group than in the group that was not followed (32% versus 21%; p It is concluded that regular follow-up detects more recurrent cancers, enabling radical reoperations significantly more often than when there is no follow-up. The outcome after curative reoperations is encouraging. These aspects favor regular followup of patients with colorectal carcinoma after curative operations., Approximately one-third of all patients who undergo radical surgery for colorectal cancer (cancer of the colon and rectum) experience a recurrence of cancer, and many of these patients can be helped by additional surgery. The success of this procedure, however, is greatest if the recurrence is detected early. To learn more about optimal follow-up procedures, recurrence rates for 368 Finnish patients who made regularly scheduled follow-up visits to the hospital were compared with rates for 139 patients who either did not come to scheduled visits, or who had some check-ups by private physicians according to a schedule not known to the investigators. The patients had been part of a larger group of 709 individuals treated for colorectal cancer at one institution in Finland between 1976 and 1985. Five-year survival for the follow-up group was 72 percent, and in the non-follow-up group it was 62 percent, a difference that was not statistically significant. The cancer recurrence rate was 32 percent for the follow-up group, and disease was diagnosed for the majority (83 percent) during scheduled visits. Among the patients who did not have regularly scheduled follow-up visits, the recurrence rate was 21 percent. Curative reoperation could be undertaken for 25 patients (7 percent) among the follow-up group, but for only two (7 percent) in the other group. After such reoperation, the five-year survival rate was 47 percent, and the disease-free five-year survival rate, 41 percent. The factor that most affected survival was the Dukes' classification (a method of ranking cancer severity) of the initial cancer. It had been anticipated that the recurrence rates would be similar for the follow-up and non-follow-up groups; the higher rate among followed-up patients could have been due to earlier detection, often by laboratory tests. Overall, the results support a follow-up program for the early detection of colorectal cancer recurrence, in order to improve survival rates. (Consumer Summary produced by Reliance Medical Information, Inc.)

To investigate changes in the results of treatment of gastric carcinoma, two 10-year periods between 1963 and 1982 with 641 and 630 patients, respectively, were compared. In the two groups, 94 percent and 92 percent of patients were operated on. The operation was considered curative in 200 and 265 patients in Groups 1 and 2, respectively. There was a shift towards more radical operations, with 215 total or subtotal gastrectomies in Group 2 compared with 76 in Group 1, when distal gastric resection was considered radical enough. Despite the increasing number of curative operations and more radical surgery in Group 2, no progress in the 5-year survival rate was noted. Distal and subtotal gastrectomies gave slightly better results than total gastrectomies, but the most important single factor contributing to the long-term survival was cancerous invasion of the serosa. It is concluded that in the past 20 years, the results of surgical treatment of gastric carcinoma have not improved, despite the more advanced diagnostic methods and more radical surgery., Stomach cancer is a common cancer in Finland; its incidence has decreased during the last 30 years and is now half what it was in the 1950s. No mass screenings for early identification are used. During the past 10 years increased use of endoscopy (visualization of an interior cavity of the body using an illuminated optic instrument) has increased the number of patients treated surgically to obtain cure, and the surgery performed is now more radical, with partial stomach removal being replaced by removal of the entire stomach. Comparison of treatment outcomes for two consecutive 10-year periods was undertaken to determine if the changes in surgical approach have influenced outcome. There were 641 patients treated during the first period (1963-1972), and 630 patients treated during the second period (1973-1982). Surgery was performed for 94 percent of the earlier group and 92 percent of the later group; all patients not operated on died within one year. Surgery was considered curative for 200 of the earlier group and 265 of the later group, with a shift toward more radical operations seen in the latter. Despite this, the five-year survival rates did not differ significantly between the groups. The most important factor contributing to long-term survival was the extent of cancer invasion; 75 percent of the early group and 80 percent of the later group who survived five years had no invasion of the serosa (membrane lining the stomach wall) at the time of surgery. It is concluded that in spite of advances in method of diagnosis and surgical technique, the outcome of surgery for stomach cancer has not improved over the past 20 years. (Consumer Summary produced by Reliance Medical Information, Inc.)