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Endoscopic Localization of Colon Cancer Is Frequently Inaccurate

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Abstract

Background

Colonoscopic location of a tumor can influence both the surgical procedure choice and overall treatment strategy.

Aims

To determine the accuracy of colonoscopy in determining the location of colon cancer compared to surgical localization and to elucidate factors that predict discordant colon cancer localization.

Methods

We conducted a retrospective cross-sectional study of colon cancers diagnosed on colonoscopy at two academic tertiary-care hospitals and two affiliated community hospitals from 2012 to 2014. Colon cancer location was obtained from the endoscopic and surgical pathology reports and characterized by colon segment. We collected data on patient demographics, tumor characteristics, endoscopic procedure characteristics, surgery planned, and surgery performed. Univariate analyses using Chi-squared test and multivariate analysis using forward stepwise logistic regression were performed to determine factors that predict discordant colon cancer localization.

Results

There were 110 colon cancer cases identified during the study period. Inaccurate endoscopic colon cancer localization was found in 29% (32/110) of cases. These included 14 cases (12.7%) that were discordant by more than one colonic segment and three cases where the presurgical planned procedure was significantly changed at the time of surgery. On univariate analyses, right-sided colon lesions were associated with increased inaccuracy (43.8 vs 24.4%, p = 0.04). On multivariate analysis, right-sided colon lesions remained independently associated with inaccuracy (OR 1.74, 95% CI 1.03–2.93, p = 0.04).

Conclusions

Colon cancer location as determined by colonoscopy is often inaccurate, which can result in intraoperative changes to surgical management, particularly in the right colon.

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References

  1. Bardakcioglu O, Khan A, Aldridge C, et al. Growth of laparoscopic colectomy in the united states: analysis of regional and socioeconomic factors over time. Ann Surg. 2013;258:270–274.

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  4. Louis MA, Nandipati K, Astorga R, et al. Correlation between preoperative endoscopic and intraoperative findings in localizing colorectal lesions. World J Surg. 2010;34:1587–1591.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  6. Borda F, Jimenez FJ, Borda A, et al. Endoscopic localization of colorectal cancer: study of its accuracy and possible error factors. Rev Esp Enferm Dig. 2012;104:512–517.

    Article  CAS  PubMed  Google Scholar 

  7. Solon JG, Al-Azawi D, Hill A, et al. Colonoscopy and computerized tomography scan are not sufficient to localize right-sided colonic lesions accurately. Colorectal Dis. 2010;12:e267–e272.

    Article  CAS  PubMed  Google Scholar 

  8. Bryce AS, Johnstone MS, Moug SJ. Improving lesion localisation at colonoscopy: an analysis of influencing factors. Int J Colorectal Dis. 2015;30:111–118.

    Article  PubMed  Google Scholar 

  9. Kenig J, Richter P. Definition of the rectum and level of the peritoneal reflection—still a matter of debate? Wideochir Inne Tech Maloinwazyjne. 2013;8:183–186.

    PubMed  PubMed Central  Google Scholar 

  10. McMullen TP, Easson AM, Cohen Z, et al. The investigation of primary rectal cancer by surgeons: current pattern of practice. Can J Surg. 2005;48:19–26.

    PubMed  PubMed Central  Google Scholar 

  11. Wasserman MA, McGee MF, Helenowski IB, et al. The anthropometric definition of the rectum is highly variable. Int J Colorectal Dis. 2016;31:189–195.

    Article  PubMed  Google Scholar 

  12. Nelson H, Petrelli N, Carlin A, et al. Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst. 2001;93:583–596.

    Article  CAS  PubMed  Google Scholar 

  13. Schoellhammer HF, Gregorian AC, Sarkisyan GG, et al. How important is rigid proctosigmoidoscopy in localizing rectal cancer? Am J Surg. 2008;196:904–908. (discussion 908).

    Article  PubMed  Google Scholar 

  14. Pilipshen SJ, Heilweil M, Quan SH, et al. Patterns of pelvic recurrence following definitive resections of rectal cancer. Cancer. 1984;53:1354–1362.

    Article  CAS  PubMed  Google Scholar 

  15. Ellul P, Fogden E, Simpson C, et al. Colonic tumour localization using an endoscope positioning device. Eur J Gastroenterol Hepatol. 2011;23:488–491.

    Article  PubMed  Google Scholar 

  16. Cho YB, Lee WY, Yun HR, et al. Tumor localization for laparoscopic colorectal surgery. World J Surg. 2007;31:1491–1495.

    Article  PubMed  Google Scholar 

  17. Arteaga-González I, Martín-Malagón A, Fernández EM, et al. The use of preoperative endoscopic tattooing in laparoscopic colorectal cancer surgery for endoscopically advanced tumors: a prospective comparative clinical study. World J Surg. 2006;30:605–611.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02446, USA

    Jennifer Nayor, Stephen R. Rotman, Walter W. Chan & John R. Saltzman

  2. Harvard Medical School, Boston, MA, USA

    Jennifer Nayor, Stephen R. Rotman, Walter W. Chan, Joel E. Goldberg & John R. Saltzman

  3. Division of General and Gastrointestinal Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Joel E. Goldberg

Authors
  1. Jennifer Nayor
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  2. Stephen R. Rotman
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  3. Walter W. Chan
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  4. Joel E. Goldberg
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  5. John R. Saltzman
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Correspondence to Jennifer Nayor.

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Additional information

Jennifer Nayor and Stephen R. Rotman are co-first authors.

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Nayor, J., Rotman, S.R., Chan, W.W. et al. Endoscopic Localization of Colon Cancer Is Frequently Inaccurate. Dig Dis Sci 62, 2120–2125 (2017). https://doi.org/10.1007/s10620-017-4591-1

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  • DOI: https://doi.org/10.1007/s10620-017-4591-1

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