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A comparison of endoscopic localization error rate between operating surgeons and referring endoscopists in colorectal cancer

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Abstract

Background

Colonoscopy for colorectal cancer (CRC) has a localization error rate as high as 21 %. Such errors can have substantial clinical consequences, particularly in laparoscopic surgery. The primary objective of this study was to compare accuracy of tumor localization at initial endoscopy performed by either the operating surgeon or non-operating referring endoscopist.

Methods

All patients who underwent surgical resection for CRC at a large tertiary academic hospital between January 2006 and August 2014 were identified. The exposure of interest was the initial endoscopist: (1) surgeon who also performed the definitive operation (operating surgeon group); and (2) referring gastroenterologist or general surgeon (referring endoscopist group). The outcome measure was localization error, defined as a difference in at least one anatomic segment between initial endoscopy and final operative location. Multivariate logistic regression was used to explore the association between localization error rate and the initial endoscopist.

Results

A total of 557 patients were included in the study; 81 patients in the operating surgeon cohort and 476 patients in the referring endoscopist cohort. Initial diagnostic colonoscopy performed by the operating surgeon compared to referring endoscopist demonstrated statistically significant lower intraoperative localization error rate (1.2 vs. 9.0 %, P = 0.016); shorter mean time from endoscopy to surgery (52.3 vs. 76.4 days, P = 0.015); higher tattoo localization rate (32.1 vs. 21.0 %, P = 0.027); and lower preoperative repeat endoscopy rate (8.6 vs. 40.8 %, P < 0.001). Initial endoscopy performed by the operating surgeon was protective against localization error on both univariate analysis, OR 7.94 (95 % CI 1.08–58.52; P = 0.016), and multivariate analysis, OR 7.97 (95 % CI 1.07–59.38; P = 0.043).

Conclusions

This study demonstrates that diagnostic colonoscopies performed by an operating surgeon are independently associated with a lower localization error rate. Further research exploring the factors influencing localization accuracy and why operating surgeons have lower error rates relative to non-operating endoscopists is necessary to understand differences in care.

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References

  1. Siegel R, Desantis C, Jemal A (2014) Colorectal cancer statistics, 2014. CA Cancer J Clin 64:104–117

    Article  PubMed  Google Scholar 

  2. Kohler BA, Sherman RL, Howlader N, Jemal A, Ryerson AB, Henry KA, Boscoe FP, Cronin KA, Lake A, Noone AM, Henley SJ, Eheman CR, Anderson RN, Penberthy L (2015) Annual report to the nation on the status of cancer, 1975–2011, featuring incidence of breast cancer subtypes by race/ethnicity, poverty, and state. J Natl Cancer Inst 107:djv048. doi:10.1093/jnci/djv048

    Article  PubMed  PubMed Central  Google Scholar 

  3. Edwards BK, Ward E, Kohler BA, Eheman C, Zauber AG, Anderson RN, Jemal A, Schymura MJ, Lansdorp-Vogelaar I, Seeff LC, van Ballegooijen M, Goede SL, Ries LA (2010) Annual report to the nation on the status of cancer, 1975–2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer 116:544–573

    Article  PubMed  PubMed Central  Google Scholar 

  4. Atkin W, Dadswell E, Wooldrage K, Kralj-Hans I, von Wagner C, Edwards R, Yao G, Kay C, Burling D, Faiz O, Teare J, Lilford RJ, Morton D, Wardle J, Halligan S, SIGGAR investigators (2013) Computed tomographic colonography versus colonoscopy for investigation of patients with symptoms suggestive of colorectal cancer (SIGGAR): a multicentre randomised trial. Lancet 381:1194–1202

    Article  PubMed  Google Scholar 

  5. Pickhardt PJ, Hassan C, Halligan S, Marmo R (2011) Colorectal cancer: CT colonography and colonoscopy for detection–systematic review and meta-analysis. Radiology 259:393–405

    Article  PubMed  PubMed Central  Google Scholar 

  6. Stanciu C, Trifan A, Khder SA (2007) Accuracy of colonoscopy in localizing colonic cancer. Rev Med Chir Soc Med Nat Iasi 111:39–43

    CAS  PubMed  Google Scholar 

  7. Vaziri K, Choxi SC, Orkin BA (2010) Accuracy of colonoscopic localization. Surg Endosc 24:2502–2505

    Article  PubMed  Google Scholar 

  8. Louis MA, Nandipati K, Astorga R, Mandava A, Rousseau CP, Mandava N (2010) Correlation between preoperative endoscopic and intraoperative findings in localizing colorectal lesions. World J Surg 34:1587–1591

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  10. 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 

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

    Article  PubMed  Google Scholar 

  12. Borda F, Jimenez FJ, Borda A, Urman J, Goni S, Ostiz M, Zozaya JM (2012) Endoscopic localization of colorectal cancer: study of its accuracy and possible error factors. Rev Esp Enferm Dig 104:512–517

    Article  CAS  PubMed  Google Scholar 

  13. 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 

  14. 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 28:2808–2814

    Article  PubMed  Google Scholar 

  15. Keller D, Jaffe J, Philp MM, Haluszka O, Khanna A (2012) Should all endoscopically excised rectal polyps be tattooed? A plea for localization. Surg Endosc 26:3101–3105

    Article  PubMed  Google Scholar 

  16. Zafar A, Mustafa M, Chapman M (2012) Colorectal polyps: when should we tattoo? Surg Endosc 26:3264–3266

    Article  PubMed  Google Scholar 

  17. Saleh F, Abbasi TA, Cleghorn M, Jimenez MC, Jackson TD, Okrainec A, Quereshy FA (2015) Preoperative endoscopy localization error rate in patients with colorectal cancer. Surg Endosc 29:2569–2575

    Article  PubMed  Google Scholar 

  18. Kim SH, Milsom JW, Church JM, Ludwig KA, Garcia-Ruiz A, Okuda J, Fazio VW (1997) Perioperative tumor localization for laparoscopic colorectal surgery. Surg Endosc 11:1013–1016

    Article  CAS  PubMed  Google Scholar 

  19. Sharara N, Adam V, Crott R, Barkun AN (2008) The costs of colonoscopy in a Canadian hospital using a microcosting approach. Can J Gastroenterol 22:565–570

    Article  PubMed  PubMed Central  Google Scholar 

  20. Rabeneck L, Paszat LF, Saskin R (2010) Endoscopist specialty is associated with incident colorectal cancer after a negative colonoscopy. Clin Gastroenterol Hepatol 8:275–279

    Article  PubMed  Google Scholar 

  21. Baxter NN, Sutradhar R, Forbes SS, Paszat LF, Saskin R, Rabeneck L (2011) Analysis of administrative data finds endoscopist quality measures associated with postcolonoscopy colorectal cancer. Gastroenterology 140:65–72

    Article  PubMed  Google Scholar 

  22. 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  PubMed Central  Google Scholar 

  23. Baxter NN, Warren JL, Barrett MJ, Stukel TA, Doria-Rose VP (2012) Association between colonoscopy and colorectal cancer mortality in a US cohort according to site of cancer and colonoscopist specialty. J Clin Oncol 30:2664–2669

    Article  PubMed  PubMed Central  Google Scholar 

  24. Singh H, Nugent Z, Demers AA, Bernstein CN (2010) Rate and predictors of early/missed colorectal cancers after colonoscopy in Manitoba: a population-based study. Am J Gastroenterol 105:2588–2596

    Article  PubMed  Google Scholar 

  25. ASGE Standards of Practice Committee (2013) Role of endoscopy in the staging and management of colorectal cancer. Gastrointest Endosc 78(3):559

    Article  Google Scholar 

  26. Ellis KK, Fennerty MB (1997) Marking and identifying colon lesions. Tattoos, clips, and radiology in imaging the colon. Gastrointest Endosc Clin N Am 7:401–411

    CAS  PubMed  Google Scholar 

  27. Yeung JM, Maxwell-Armstrong C, Acheson AG (2009) Colonic tattooing in laparoscopic surgery–making the mark? Colorectal Dis 11:527–530

    Article  CAS  PubMed  Google Scholar 

  28. Jimenez MC, Azin A, Saleh F, Diamant A, Jackson TD, Okrainec A, Quereshy FA (2014) Preoperative repeat endoscopy for colorectal cancer: attitudes, perceptions and practices of General Surgeons. Poster session SAGES, Salt Lake City

    Google Scholar 

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Acknowledgments

Azin, Saleh, Jackson, Okrainec, and Quereshy were involved in study conception and design. Azin and Yuen acquired the data. Azin, Saleh, and Cleghorn analyzed and interpreted the data. Azin and Saleh drafted the manuscript. Cleghorn, Yuen, Jackson, Okrainec, and Quereshy critically revised the manuscript for important intellectual content. All authors approved the final version of the manuscript to be published.

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Authors and Affiliations

  1. Division of General Surgery, University of Toronto, Toronto, ON, Canada

    Arash Azin, Andrew Yuen, Timothy Jackson, Allan Okrainec & Fayez A. Quereshy

  2. Division of General Surgery, William Osler Health System, Etobicoke, ON, Canada

    Fady Saleh

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

    Fady Saleh, Michelle Cleghorn, Timothy Jackson, Allan Okrainec & Fayez A. Quereshy

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  1. Arash Azin
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  2. Fady Saleh
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  3. Michelle Cleghorn
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  4. Andrew Yuen
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  5. Timothy Jackson
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  7. Fayez A. Quereshy
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Correspondence to Fayez A. Quereshy.

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Disclosures

Drs. Azin, Saleh, Cleghorn, Yuen, Jackson, Okrainec, and Quereshy have no conflicts of interest or financial ties to disclose.

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Azin, A., Saleh, F., Cleghorn, M. et al. A comparison of endoscopic localization error rate between operating surgeons and referring endoscopists in colorectal cancer. Surg Endosc 31, 1318–1326 (2017). https://doi.org/10.1007/s00464-016-5114-4

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  • DOI: https://doi.org/10.1007/s00464-016-5114-4

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