A wide variety of follow-up strategies are used for patients with colorectal cancer (CRC) after curative surgery. The aim of this study is to review the evidence of the impact of different follow-up strategies in patients with nonmetastatic CRC after curative surgery, in relation to overall survival and other outcomes. A systematic search of PubMed, EMBASE, SCOPUS and ISI Web of Knowledge up to June 2014 was carried out. Eligible studies were all randomized clinical trials comparing the effectiveness of different follow-up strategies after curative resection in nonmetastatic CRC. Eleven studies with n = 4055 participants were included in a meta-analysis. A significant improvement in overall survival was observed in patients with more intensive follow-up strategies [hazard ratio = 0.75; 95% confidence interval (CI) 0.66–0.86]. A higher probability of detection of asymptomatic recurrences [relative risk (RR) = 2.59; 95% CI 1.66–4.06], curative surgery attempted at recurrences (RR = 1.98; 95% CI 1.51–2.60), survival after recurrences (RR = 2.13; 95% CI 1.24–3.69), and a shorter time in detecting recurrences (mean difference = −5.23 months; 95% CI −9.58 to −0.88) was observed in the intervention group. There were no significant differences in the total tumor recurrences, nor in the mortality related to disease. Intensive follow-up strategies improve overall survival, increase the detection of asymptomatic recurrences and curative surgery attempted at recurrence, and are associated with a shorter time in detecting recurrences. This more intensive follow-up could not be associated with an improvement in cancer-specific survival nor with an increased detection of total tumor recurrences. Follow-up with serum carcinoembryonic antigen and colonoscopies are related to an increase in overall survival.

Journal of Clinical and Diagnostic Research aims to publish findings of doctors at grass root level and post graduate students, so that all unique medical experiences are recorded in literature.

Research is needed to determine the prevalence and variables associated with the diagnosis of flatfoot, and to evaluate the validity of three footprint analysis methods for diagnosing flatfoot, using clinical diagnosis as a benchmark. We conducted a cross-sectional study of a population-based random sample ≥ 40 years old (n = 1002) in A Coruña, Spain. Anthropometric variables, Charlson's comorbidity score, and podiatric examination (including measurement of Clarke's angle, the Chippaux-Smirak index, and the Staheli index) were used for comparison with a clinical diagnosis method using a podoscope. Multivariate regression was performed. Informed patient consent and ethical review approval were obtained. Prevalence of flatfoot in the left and right footprint, measured using the podoscope, was 19.0% and 18.9%, respectively. Variables independently associated with flatfoot diagnosis were age (OR 1.07), female gender (OR 3.55) and BMI (OR 1.39). The area under the receiver operating characteristic curve (AUC) showed that Clarke's angle is highly accurate in predicting flatfoot (AUC 0.94), followed by the Chippaux-Smirak (AUC 0.83) and Staheli (AUC 0.80) indices. Sensitivity values were 89.8% for Clarke's angle, 94.2% for the Chippaux-Smirak index, and 81.8% for the Staheli index, with respective positive likelihood ratios or 9.7, 2.1, and 2.0. Age, gender, and BMI were associated with a flatfoot diagnosis. The indices studied are suitable for diagnosing flatfoot in adults, especially Clarke's angle, which is highly accurate for flatfoot diagnosis in this population.

To investigate the usefulness of multistate models (MSM) for determining colorectal cancer (CRC) recurrence rate, to analyse the effect of different factors on tumour recurrence and death, and to assess the impact of recurrence for CRC prognosis. Observational follow-up study of incident CRC cases disease-free after curative resection in 2006-2013 (n = 994). Recurrence and mortality were analyzed with MSM, as well as covariate effects on transition probabilities. Cumulative incidence of recurrence at 60 months was 13.7%. Five years after surgery, 70.3% of patients were alive and recurrence-free, and 8.4% were alive after recurrence. Recurrence has a negative impact on prognosis, with 5-year CRC-related mortality increasing from 3.8% for those who are recurrence-free 1-year after surgery to 33.6% for those with a recurrence. Advanced stage increases recurrence risk (HR = 1.53) and CRC-related mortality after recurrence (HR = 2.35). CRC-related death was associated with age in recurrence-free patients, and with comorbidity after recurrence. As expected, age≥75 years was a risk factor for non-CRC-related death with (HR = 7.76) or without recurrence (HR = 4.26), while its effect on recurrence risk was not demonstrated. MSM allows detailed analysis of recurrence and mortality in CRC. Recurrence has a negative impact on prognosis. Advanced stage was a determining factor for recurrence and CRC-death after recurrence.

Disparate and contradictory results make studies necessary to investigate in more depth the relationship between diagnostic delay and survival in colorectal cancer (CRC) patients. The aim of this study is to analyse the relationship between the interval from first symptom to diagnosis (SDI) and survival in CRC. Retrospective study of n = 942 CRC patients. SDI was calculated as the time from the diagnosis of cancer and the first symptoms of CRC. Cox regression was used to estimate five-year mortality hazard ratios as a function of SDI, adjusting for age and gender. SDI was modelled according to SDI quartiles and as a continuous variable using penalized splines. Median SDI was 3.4 months. SDI was not associated with stage at diagnosis (Stage I = 3.6 months, Stage II-III = 3.4, Stage IV = 3.2; p = 0.728). Shorter SDIs corresponded to patients with abdominal pain (2.8 months), and longer SDIs to patients with muchorrhage (5.2 months) and rectal tenesmus (4.4 months). Adjusting for age and gender, in rectum cancers, patients within the first SDI quartile had lower survival (p = 0.003), while in colon cancer no significant differences were found (p = 0.282). These results do not change after adjusting for TNM stage. The splines regression analysis revealed that, for rectum cancer, 5-year mortality progressively increases for SDIs lower than the median (3.7 months) and decreases as the delay increases until approximately 8 months. In colon cancer, no significant relationship was found between SDI and survival. Short diagnostic intervals are significantly associated with higher mortality in rectal but not in colon cancers, even though a borderline significant effect is also observed in colon cancer. Longer diagnostic intervals seemed not to be associated with poorer survival. Other factors than diagnostic delay should be taken into account to explain this “waiting-time paradox”.