Which follow-up for colorectal cancer? Perhaps none John MA Northover

For most surgeons, postoperative follow-up is as much a part of colorectal cancer surgery as bowel preparation or closing the skin, but reliable evidence that this complex and costly process improves overall survival is lacking. Nevertheless, health systems around the world allow this to go on, despite tight resources and an increasing expectation of provable benefit from any health intervention. A recent US survey of different follow-up regimens showed a wide range of costs for five years of follow-up per patient;1 the cheapest they found was $900, while the most expensive was nearly $27 000. With a million follow-up visits generated by each year’s cohort of new US cases, this amounts to billions spent, but for what benefit? And the situation is similar in all industrialized countries.