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Surveillance colonoscopy after colorectal cancer resection may be safely delayed
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The time between colorectal cancer resection and the first postoperative surveillance colonoscopy may be safely extended beyond the current recommendation of 1 year, according to data presented at the American Society of Colon and Rectal Surgeons Annual Meeting in Phoenix.
Researchers evaluated 151 patients (mean age, 68 years) collected from the Ochsner Clinic Tumor Registry Database who had undergone segmental colectomy or proctectomy between 2002 and 2010. Procedures included right colectomy (51.7% of cases), low anterior resection (21.2%), sigmoid colectomy (18.5%), left colectomy (7.3%) and transanal resection (1.3%).
All participants received preoperative and one or more postoperative colonoscopies, with a mean time of 460 ± 285 days between surgery and postoperative colonoscopy, and all procedures were performed at the Ochsner Clinic in New Orleans. Incidence of new cancer or polyps of 1 cm or larger observed on postoperative colonoscopy was recorded.
Stage 0 cancer was present in 2.6% of the cohort; 30.5% had stage I, 33.8% had stage II, 27.8% had stage III and 5.3% had stage IV cancers. Adenomatous polyps were observed upon initial surveillance colonoscopy in 24 cases, including seven with polyps of 1 cm or larger. New cancer was undetected, but investigators said four patients experienced anastomotic recurrence, most often (75% of cases) among those who underwent rectal resection. No significant correlations were observed between cancer stage and either polyps on colonoscopy or recurrence.
“In our institution, performing surveillance colonoscopy at 1 year resulted in the detection of only seven missed polyps [of 1 cm or larger] and no missed synchronous cancers,” the researchers wrote. “Anastomotic recurrences were rare and the vast majority were in the rectum, which could be evaluated by an in-office flexible sigmoidoscopy. Extending the time to first colonoscopy after resection may be safe, and would help conserve valuable resources including physician and facility time.”
For more information:
Cone MM. S58: Timing of Colonoscopy After Resection for Colorectal Cancer: Are We Looking Too Soon? Presented at: The American Society of Colon and Rectal Surgeons Annual Meeting 2013; April 27–May 1, Phoenix.