Skip to main content

Advertisement

SpringerLink
Log in

Preoperative endoscopy localization error rate in patients with colorectal cancer

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Preoperative repeat endoscopy in colorectal cancer (CRC) patients is considered by many to be an integral component of surgical planning. Little is known, however, about the utility of re-endoscopy.

Methods

A retrospective review of 342 consecutive patients undergoing elective surgical resection for CRC from January 2008 to December 2011 was performed. Patients were included if the initial endoscopist was different than the operating surgeon. A localization error was recorded if the final tumor location identified during surgery was in a different anatomical segment than that identified by endoscopy. The Chi-squared test was used to compare categorical variables. An error rate with a 95 % confidence interval was obtained using the exact binomial distribution.

Results

298 patients were identified, 118 (39.6 %) of whom also underwent a preoperative re-endoscopy by the operating surgeon or partner. Nineteen patients had incorrect tumor localization at initial endoscopy, equivalent to a 6.4 % error rate (95 % CI 3.88–9.78). In comparison, there were two localization errors on re-endoscopy, 1.69 % (95 % CI 0.21–6.00). Re-endoscopy was found to be protective against localization errors (P < 0.05), correcting 10 of the 12 errors made at the initial endoscopy. The sensitivity of re-endoscopy as a diagnostic tool to detect errors was 83 % with a corresponding specificity of 100 %. The overall accuracy of re-endoscopy in preventing endoscopic localization errors was 92 % (95 % CI 81–100).

Conclusions

There is a small but important localization error rate in preoperative endoscopic evaluation of colorectal tumors. Re-endoscopy appears to be safe and may potentially identify and correct these errors and help with preoperative planning at the expense of delaying surgery. Further research is necessary to find ways to improve localization and identify which patients would benefit from re-endoscopy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. American Cancer Society (2013) Cancer facts and figures 2013. American Cancer Society, Atlanta

    Google Scholar 

  2. Winawer SJ, Zauber AG, Ho MN, O’Brien MJ, Gottlieb LS, Sternberg SS, Waye JD, Schapiro M, Bond JH, Panish JF, Ackroyd F, Shike M, Kurtz RC, Hornsby-Lewis L, Gerdes H, Stewart ET (1993) Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 329:1977–1981

    Article  CAS  PubMed  Google Scholar 

  3. Vignati P, Welch JP, Cohen L (1994) Endoscopic localization of colon cancers. Surg Endosc 8:1085–1087

    Article  CAS  PubMed  Google Scholar 

  4. Cho YB, Lee WY, Yun HR, Lee WS, Yun SH, Chun HK (2007) Tumor localization for laparoscopic colorectal surgery. World J Surg 31:1491–1495

    Article  PubMed  Google Scholar 

  5. Piscatelli N, Hyman N, Osler T (2005) Localizing colorectal cancer by colonoscopy. Arch Surg 140:932–935

    Article  PubMed  Google Scholar 

  6. The Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059

    Article  Google Scholar 

  7. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM, MRC CLASICC trial group, (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726

    Article  PubMed  Google Scholar 

  8. Hewett PJ, Allardyce RA, Bagshaw PF, Frampton CM, Frizelle FA, Rieger NA, Smith JS, Solomon MJ, Stephens JH, Stevenson AR (2008) Short-term outcomes of the Australasian randomised clinical study comparing laparoscopic and conventional open surgical treatments for colon cancer: the ALCCaS trial. Ann Surg 248:728–738

    Article  PubMed  Google Scholar 

  9. Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy AM, COlon cancer Laparoscopic or Open Resection Study Group (COLOR) (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484

    Article  PubMed  Google Scholar 

  10. Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ (2010) Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 97:1638–1645

    Article  CAS  PubMed  Google Scholar 

  11. Simunovic M, Baxter NN, Sutradhar R, Liu N, Cadeddu M, Urbach D (2013) Uptake and patient outcomes of laparoscopic colon and rectal cancer surgery in a publicly funded system and following financial incentives. Ann Surg Oncol 20:3740–3746

    Article  PubMed  Google Scholar 

  12. Al Abbasi T, Saleh F, Jackson TD, Okrainec A, Quereshy FA (2014) Preoperative re-endoscopy in colorectal cancer patients: an institutional experience and analysis of influencing factors. Surg Endosc. doi:10.1007/s00464-014-3549-z

    PubMed  Google Scholar 

  13. Beretvas RI, Ponsky J (2001) Endoscopic marking: an adjunct to laparoscopic gastrointestinal surgery. Surg Endosc 15:1202–1203

    Article  CAS  PubMed  Google Scholar 

  14. Lam DT, Kwong KH, Lam CW, Leong HT, Kwok SP (1998) How useful is colonoscopy in locating colorectal lesions? Surg Endosc 12:839–841

    Article  CAS  PubMed  Google Scholar 

  15. Lee J, Voytovich A, Pennoyer W, Thurston K, Kozol RA (2010) Accuracy of colon tumor localization: computed tomography scanning as a complement to colonoscopy. World J Gastrointest Surg 2:22–25

    Article  PubMed Central  PubMed  Google Scholar 

  16. National Institutes of Health (1990) Adjuvant Therapy for Patients with Colon and Rectum Cancer: NIH Consensus Statement, Vol. 8: National Institutes of Health, Bethesda (MD), pp 1-25

  17. Figueredo A, Charette ML, Maroun J, Brouwers MC, Zuraw L (2004) Adjuvant therapy for stage II colon cancer: a systematic review from the Cancer Care Ontario Program in Evidence-based Care’s Gastrointestinal Cancer Disease Site Group. J Clin Oncol 22:3395–3407

    Article  PubMed  Google Scholar 

  18. Biagi JJ, Raphael MJ, Mackillop WJ, Kong W, King WD, Booth CM (2011) Association between time to adjuvant chemotherapy and survival in colorectal cancer: a systematic review and meta-analysis. JAMA 305:2335–2342

    Article  CAS  PubMed  Google Scholar 

  19. Bayraktar UD, Chen E, Bayraktar S, Sands LR, Marchetti F, Montero AJ, Rocha-Lima CM (2011) Does delay of adjuvant chemotherapy impact survival in patients with resected stage II and III colon adenocarcinoma? Cancer 117:2364–2370

    Article  PubMed  Google Scholar 

  20. Simunovic M, Rempel E, Theriault ME, Baxter NN, Virnig BA, Meropol NJ, Levine MN (2009) Influence of delays to nonemergent colon cancer surgery on operative mortality, disease-specific survival and overall survival. Can J Surg 52:E79–E86

    PubMed Central  PubMed  Google Scholar 

  21. Iversen LH, Antonsen S, Laurberg S, Lautrup MD (2009) Therapeutic delay reduces survival of rectal cancer but not of colonic cancer. Br J Surg 96:1183–1189

    Article  CAS  PubMed  Google Scholar 

  22. Yun YH, Kim YA, Min YH, Park S, Won YJ, Kim DY, Choi IJ, Kim YW, Park SJ, Kim JH, Lee DH, Yoon SJ, Jeong SY, Noh DY, Heo DS (2012) The influence of hospital volume and surgical treatment delay on long-term survival after cancer surgery. Ann Oncol 23:2731–2737

    Article  CAS  PubMed  Google Scholar 

Download references

Disclosures

Drs. Saleh, Al Abbasi, Jimenez, Jackson, Quereshy, and Cleghorn have no conflicts of interest or financial ties to disclose. Dr. Okrainec reports grants and personal fees from Covidien.

Author information

Authors and Affiliations

  1. Division of General Surgery, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Room 8MP-320, Toronto, ON, M5T 2S8, Canada

    Fady Saleh, Thamer Al Abbasi, Michelle Cleghorn, M. Carolina Jimenez, Timothy D. Jackson, Allan Okrainec & Fayez A. Quereshy

  2. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Fady Saleh, Thamer Al Abbasi, Timothy D. Jackson, Allan Okrainec & Fayez A. Quereshy

Authors
  1. Fady Saleh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thamer Al Abbasi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michelle Cleghorn
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Carolina Jimenez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Timothy D. Jackson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Allan Okrainec
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fayez A. Quereshy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fayez A. Quereshy.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Saleh, F., Abbasi, T.A., Cleghorn, M. et al. Preoperative endoscopy localization error rate in patients with colorectal cancer. Surg Endosc 29, 2569–2575 (2015). https://doi.org/10.1007/s00464-014-3969-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-014-3969-9

Keywords

Search

Navigation