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Six-year results of annual colonoscopy after resection of colorectal cancer

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Abstract

Colonoscopy is an important diagnostic and therapeutic tool that may also be useful in the surveillance of patients after curative resection of colorectal cancer. The yield of colonoscopy and the frequency with which it should be performed after operation, however, have not been clearly defined. Over the past 10 years, we have examined these patients annually with colonoscopy or barium enema. This study evaluates the results of a specifically designed protocol that followed 174 patients.

Counting all sites, colorectal cancer recurred in 57 of 174 patients, three-quarters within the first 24 months. Nine anastomotic recurrences were detected in the 12–30 month interval; none was reoperated for cure; however, 4 metachronous colon cancers were found and resected for cure. In addition, 30 polyps larger than 1 cm in size and 7 villous adenomas were removed in 30 patients. Combined, these findings represent an interval yield of 3–5% per year. Based on these results and other reports, we recommend that patients undergo colonoscopy annually at least for the first 6 years postresection of colorectal cancer. The detection of new primary tumors and possibly predisposing lesions becomes more important in these patients than detection and cure of recurrent disease.

Résumé

La coloscopie, outil diagnostique et thérapeutique important, peut être utile également dans la surveillance des patients opérés d'un cancer colique. Cependant, la fréquence de la surveillance par coloscopie et ses bénéfices ne sont pas clairement définis. Depuis 10 ans, nous avons examiné chaque année, par une coloscopie ou un lavement baryté, 174 patients opérés d'un cancer colique.

Toutes localisations confondues, il y a eu récidive chez 57 des 174 patients. Soixante-quinze des récidives ont eu lieu au cours des 2 premières années. Neuf récidives anastomotiques ont été détectées entre 12 et 30 mois après l'opération; aucune n'a été réopérée. Cependant, on a retrouvé 4 cancers coliques métachrones qui ont été réséqués. Chez 30 patients, on a trouvé 30 polypes de diamètre <1 cm et 7 adénomes villeux qui ont pu être enlevés. Au total, le taux des investigations de surveillance positif s'est élevé à 3–5%. Compte tenu de ces résultats et des données de la littérature, nous recommandons de pratiquer une coloscopie chaque année pendant au moins 6 ans après une résection pour cancer colique. Détection et cure des nouveaux cancers ou lésions prédisposantes sont plus importantes que celles des récidives.

Resumen

La colonoscopia es un importante instrumento diagnóstico y terapéutico que también puede ser util en el seguimiento de pacientes después de resección curativa de cáncer colorrectal. Sin embargo, el rendimiento de la colonoscopia y la frecuencia con la cual debe ser realizada después de la operación, aún no han sido claramente definidos. En los últimos 10 años hemos realizado exámenes anuales de estos pacientes mediante colonoscopia o enema de bario. El presente estudio evalúa los resultados de un protocolo específicamente diseñado para el seguimiento de 174 pacientes.

Contando todas las ubicaciones, el cáncer colorrectal presentó recurrencia en 57 de 174 pacientes, tres cuartas partes de ellos en los primeras 24 meses. Nuevas recurrencias en el lugar de la anastomosis fueron detectadas en el intervalo de 12–30 meses; ningún paciente fue reoperado con el propósito de curación. Sin embargo, se encontraron 4 cánceres colónicos metacrónicos y todos fueron resecados con propósito curativo. Además, 30 pólipos >1 cm y 7 adenomas vellosos fueron resecados en 30 pacientes. En combinación, estos hallazgos representan un rendimiento de intervalo de 3–5% por año. Con base en estos resultados y en otros reportes, nosotros recomendamos que los pacientes deben ser sometidos a colonoscopia anual, por lo menos por los primeras 6 años después de la resección de un cancer colorrectal. La detección de nuevos tumores primarios y de lesiones potencialmente precursoras aparece como algo más importante que la detección y cura de enfermedad recurrente.

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References

  1. Knutson, C.O., Max, M.H.: Diagnostic and therapeutic colonoscopy. Arch. Surg.114:430, 1979

    Google Scholar 

  2. Finan, P.J., Ritchie, J.K., Hawley, P.R.: Synchronous and “early” metachronous carcinomas of the colon and rectum. Br. J. Surg.74:945, 1987

    Google Scholar 

  3. Reiley, J.C., Rusin, L.C., Theuerkauf, J.R.: Colonoscopy: Its role in cancer of the colon and rectum. Dis. Colon Rectum25:532, 1982

    Google Scholar 

  4. Kronborg, O., Hage, E., Deichgraeber, E.: The remaining colon after radical surgery for colorectal cancer: The first three years of a prospective study. Dis. Colon Rectum26:172, 1983

    Google Scholar 

  5. Weber, C.A., Deveney, K.E.: Routine colonoscopy in the management of colorectal carcinoma. Am. J. Surg.152:87, 1986

    Google Scholar 

  6. Unger, S.W., Wanebo, H.J.: Colonoscopy: An essential monitoring technique after resection of colorectal cancer. Am. J. Surg.145:71, 1983

    Google Scholar 

  7. Sugarbaker, P.H., Gianola, F.J.: A simplified plan for follow-up of patients with colon and rectal cancer supported by prospective studies of laboratory and radiologic test results. Surgery102:79, 1987

    Google Scholar 

  8. Larson, G.M., Bond, S.J., Shallcross, C., Mullins, R., Polk, Jr., H.C.: Colonoscopy after curative resection of colorectal cancer. Arch. Surg.121:535, 1986

    Google Scholar 

  9. Polk, Jr., H.C., Spratt, J.S.: Recurrent colorectal carcinoma: Detection treatment and other considerations. Surgery69:9, 1971

    Google Scholar 

  10. Welch, J.P., Donaldson, G.A.: Detection and treatment of recurrent cancer of the colon and rectum. Am. J. Surg.135:505, 1978

    Google Scholar 

  11. Polk, Jr., H.C., Spratt, J.S.: Recurrent cancer of the colon. Surg. Clin. North Am.63:151, 1983

    Google Scholar 

  12. Spratt, J.S., Spjut, J.H.: Prevalence and prognosis of individual clinical and pathologic variables associated with colorectal carcinoma. Cancer20:1976, 1967

    Google Scholar 

  13. Buhler, H., Seefeld, U., Deyhle, P.: Endoscopic follow-up after colorectal cancer surgery: Early detection of local recurrence? Cancer54:791, 1984

    Google Scholar 

  14. Polk, Jr., H.C., Spratt, J.S.: The results of treatment for perineal recurrence of cancer of the rectum. Cancer43:952, 1979

    Google Scholar 

  15. Shinya, H., Wolff, W.I.: Morphology, anatomic distribution and cancer potential of colonic polyps. Ann. Surg.190:679, 1979

    Google Scholar 

  16. Morson, B.C.: The polyp-cancer sequence in the large bowel. Proc. R. Soc. Med.67:451, 1974

    Google Scholar 

  17. Webb, W.A., McDaniel, L., Jones, L.: Experience with 1,000 colonoscopic polypectomies. Ann. Surg.201:626, 1985

    Google Scholar 

  18. Nava, H.R., Pagana, T.J.: Postoperative surveillance of colorectal carcinoma. Cancer49:1043, 1982

    Google Scholar 

  19. Coller, J.A., Corman, M.L., Weidenheimer, M.C.: Colonic polypoid disease: Need for total colonoscopy. Am. J. Surg.131:490, 1976

    Google Scholar 

  20. Netscher, D.T., Larson, G.M.: Colon cancer: The left to right shift and its implications. Surg. Gastroenterol.2:13, 1983

    Google Scholar 

  21. Langevin, J.M., Nivatvongs, S.: The true incidence of synchronous cancer of the large bowel: A prospective study. Am. J. Surg.147:330, 1984

    Google Scholar 

  22. Wolff, W.I., Shinya, H., Geffen, A.: Comparison of colonoscopy and the contrast enema in 500 patients with colorectal disease. Am. J. Surg.129:181, 1975

    Google Scholar 

  23. Martin, E.W., Minton, J.P., Carey, L.C.: CEA-directed secondlook surgery in the asymptomatic patient after primary resection of colorectal carcinoma. Ann. Surg.202:310, 1985

    Google Scholar 

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Juhl, G., Larson, G.M., Mullins, R. et al. Six-year results of annual colonoscopy after resection of colorectal cancer. World J. Surg. 14, 255–260 (1990). https://doi.org/10.1007/BF01664886

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