Abstract
Purpose
Surveillance colonoscopy is undertaken after resection of colorectal cancer to detect and treat local recurrence and metachronous lesions, with the aim of improving survival. This study aimed to clarify the current timing of surveillance colonoscopies and evaluate the rates of local recurrence and metachronous tumors.
Methods
We retrospectively analyzed data from 459 patients who underwent surveillance colonoscopy at our institution after curative resection of colorectal cancer. The number and timing of surveillance colonoscopies, incidence of local recurrence and metachronous lesions, pathological findings of lesions, treatment of lesions, and outcomes were recorded.
Results
The first surveillance colonoscopy was undertaken at 6–18 months after surgery in 73 % of patients. Local recurrence was detected in three cases (0.7 %), all during the first surveillance colonoscopy, which was performed >1 year after surgery. These three patients all underwent additional surgery and were alive 5 years later. Invasive metachronous cancers were detected in six patients (1.3 %) at 18–57 months after surgery, and advanced adenomas were detected in 30 patients.
Conclusion
Considering the low incidence of postoperative lesions and the timing of lesion detection, reducing the number of surveillance colonoscopies after surgery for colorectal cancer may be appropriate.
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References
Togashi K, Konishi F, Ozawa A, Sato T, Shito K, Kashiwagi H, Okada M, Nagai H (2000) Predictive factors for detecting colorectal carcinomas in surveillance colonoscopy after colorectal cancer surgery. Dis Colon Rectum 43:S47–S53
Tjandra JJ, Chan MK (2007) Follow-up after curative resection of colorectal cancer: a meta-analysis. Dis Colon Rectum 50:1783–1799
Renehan AG, Egger M, Saunders MP, O'Dwyer ST (2002) Impact on survival of intensive follow up after curative resection for colorectal cancer: systematic review and meta-analysis of randomised trials. BMJ 324:813
Figueredo A, Rumble RB, Maroun J, Earle CC, Cummings B, McLeod R, Zuraw L, Zwaal C, Gastrointestinal Cancer Disease Site Group of Cancer Care Ontario's Program in Evidence-based Care (2003) Follow-up of patients with curatively resected colorectal cancer: a practice guideline. BMC Cancer 3:26
Rodríguez-Moranta F, Saló J, Arcusa A, Boadas J, Piñol V, Bessa X, Batiste-Alentorn E, Lacy AM, Delgado S, Maurel J, Piqué JM, Castells A (2006) Postoperative surveillance in patients with colorectal cancer who have undergone curative resection: a prospective, multicenter, randomized, controlled trial. J Clin Oncol 24:386–393
Laubert T, Bader FG, Oevermann E, Jungbluth T, Unger L, Roblick UJ, Bruch HP, Mirow L et al (2010) Intensified surveillance after surgery for colorectal cancer significantly improves survival. Eur J Med Res 15:25–30
Fora A, Patta A, Attwood K, Wilding G, Fakih M (2012) Intensive radiographic and biomarker surveillance in stage II and III colorectal cancer. Oncology 82:41–47
Rex DK, Kahi CJ, Levin B, Smith RA, Bond JH, Brooks D, Burt RW, Byers T, Fletcher RH, Hyman N, Johnson D, Kirk L, Lieberman DA, Levin TR, O’Brien MJ, Simmang C, Thorson AG, Winawer SJ, American Cancer Society; US Multi-Society Task Force on Colorectal Cancer (2006) Guidelines for colonoscopy surveillance after cancer resection: a consensus update by the American Cancer Society and the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 130:1865–1871
Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y, Hamaguchi T, Hyodo I, Igarashi M, Ishida H, Ishiguro M, Kanemitsu Y, Kokudo N, Muro K, Ochiai A, Oguchi M, Ohkura Y, Saito Y, Sakai Y, Ueno H, Yoshino T, Fujimori T, Koinuma N, Morita T, Nishimura G, Sakata Y, Takahashi K, Takiuchi H, Tsuruta O, Yamaguchi T, Yoshida M, Yamaguchi N, Kotake K, Sugihara K, Japanese Society for Cancer of the Colon and Rectum (2012) Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int J Clin Oncol 17:1–29
Winawer SJ, Zauber AG, Ho MN, O'Brien MJ, Gottlieb LS, Sternberg SS, Waye JD, Schapiro M, Bond JH, Panish JF et al (1993) Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 329:1977–1981
Zauber AG, Winawer SJ, O'Brien MJ, Lansdorp-Vogelaar I, van Ballegooijen M, Hankey BF, Shi W, Bond JH, Schapiro M, Panish JF, Stewart ET, Waye JD (2012) Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 366:687–696
Citarda F, Tomaselli G, Capocaccia R, Barcherini S, Crespi M; Italian Multicentre Study Group (2001) Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence. Gut 48:812–815
Brenner H, Chang-Claude J, Seiler CM, Rickert A, Hoffmeister M (2011) Protection from colorectal cancer after colonoscopy: a population-based, case–control study. Ann Intern Med 154:22–30
Ross AS, Waxman I (2006) Flat and depressed neoplasms of the colon in Western populations. Am J Gastroenterol 101:172–180
Hosokawa O, Shirasaki S, Kaizaki Y, Hayashi H, Douden K, Hattori M (2003) Invasive colorectal cancer detected up to 3 years after a colonoscopy negative for cancer. Endoscopy 35:506–510
Soetikno RM, Kaltenbach T, Rouse RV, Park W, Maheshwari A, Sato T, Matsui S, Friedland S (2008) Prevalence of nonpolypoid (flat and depressed) colorectal neoplasms in asymptomatic and symptomatic adults. JAMA 299:1027–1035
Chiu HM, Lin JT, Chen CC, Lee YC, Liao WC, Liang JT, Shun CT, Wang HP, Wu MS (2009) Prevalence and characteristics of nonpolypoid colorectal neoplasm in an asymptomatic and average-risk Chinese population. Clin Gastroenterol Hepatol 7:463–470
Matsuda T, Saito Y, Hotta K, Sano Y, Fujii T (2010) Prevalence and clinicopathological features of nonpolypoid colorectal neoplasms: should we pay more attention to identifying flat and depressed lesions? Dig Endosc 22:S57–S62
Lebwohl B, Kastrinos F, Glick M, Rosenbaum AJ, Wang T, Neugut AI (2011) The impact of suboptimal bowel preparation on adenoma miss rates and the factors associated with early repeat colonoscopy. Gastrointest Endosc 73:1207–1214
Chokshi RV, Hovis CE, Hollander T, Early DS, Wang JS (2012) Prevalence of missed adenomas in patients with inadequate bowel preparation on screening colonoscopy. Gastrointest Endosc 75:1197–1203
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Sakamoto, T., Matsuda, T., Nakajima, T. et al. How often should we perform surveillance colonoscopy after surgery for colorectal cancer?. Int J Colorectal Dis 28, 835–840 (2013). https://doi.org/10.1007/s00384-012-1613-5
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DOI: https://doi.org/10.1007/s00384-012-1613-5