Risk for CRC Recurrence After Surgery Is Falling

M. Alexander Otto, PA, MMS

November 20, 2023


Along with improvements in colorectal cancer (CRC) survival, recurrence after surgery has also dropped significantly over the past 20 years.


  • Although advances over the past 20 years have improved CRC survival, it's not clear whether these advances have reduced the risk for recurrence after surgery.

  • To find out, investigators used national databases to review outcomes in 34,166 Danish patients with stage I-III CRC after curative-intent surgery.

  • The investigators separated patients into three treatment periods — 2004-2008, 2009-2013, and 2014-2019 — and then evaluated recurrence rates and times from surgery to recurrence.

  • In 2014, Denmark instituted a nationwide CRC screening program for people aged 50-74 years using fecal immunochemical testing.


  • Overall, the 5-year cumulative incidence of recurrence fell from 26.9% in 2004-2008 to 15.8% in 2014-2019, with time from surgery to recurrence peaking at 1 year in 2004-2008 and 3 years in 2014-2019.

  • For colon cancer, the 5-year cumulative incidence of recurrence dropped over the treatment periods from 16.3% to 6.8% for stage I disease, 21.9% to 11.6% for stage II disease, and 35.3% to 24.6% for stage III disease.

  • For rectal cancer, the 5-year cumulative incidence dropped from 19.9% to 9.5% for stage I disease, 25.8% to 18.4% for stage II disease, and 38.7% to 28.8% for stage III disease.

  • Across all stages, CRC detected by screening had a 24%-35% lower cumulative incidence of recurrence than did cancers detected clinically.


"The results of the present study show that the CRC recurrence rate has decreased substantially and continuously from 2004 to 2019," the authors concluded.

With survival improving and recurrence rates dropping, future research should explore shifting from one-size-fits-all surveillance after surgery to a more personalized approach based on recurrence risk. "We believe that the risk of CRC recurrence has become so low in selected patient groups that less intensive surveillance, or even no surveillance, may be noninferior to current guidelines," the authors said.


The work, led by Jesper Nors, MD, of Aarhus University, Denmark, was published on November 16 in JAMA Oncology.


The review was limited to a single Northern European country. The study didn't address the comparative importance of screening and treatment in reducing CRC recurrence.


The work was funded by Aarhus University, Novo Nordisk, and others. Study coauthor Claus Lindbjerg Andersen, PhD, reported receiving grants from the Novo Nordisk Foundation, Innovation Fund Denmark, and Danish Cancer Society during the study. No other disclosures were reported.

M. Alexander Otto is a physician assistant with a master's degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who worked for several major news outlets before joining Medscape. Alex is also an MIT Knight Science Journalism fellow. Email: aotto@mdedge.com


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