Gastroenterology

Gastroenterology

Volume 150, Issue 3, March 2016, Pages 758-768.e11
Gastroenterology

AGA Section
Colonoscopy Surveillance After Colorectal Cancer Resection: Recommendations of the US Multi-Society Task Force on Colorectal Cancer

https://doi.org/10.1053/j.gastro.2016.01.001Get rights and content

The US Multi-Society Task Force has developed updated recommendations to guide health care providers with the surveillance of patients after colorectal cancer (CRC) resection with curative intent. This document is based on a critical review of the literature regarding the role of colonoscopy, flexible sigmoidoscopy, endoscopic ultrasound, fecal testing and CT colonography in this setting. The document addresses the effect of surveillance, with focus on colonoscopy, on patient survival after CRC resection, the appropriate use and timing of colonoscopy for perioperative clearing and for postoperative prevention of metachronous CRC, specific considerations for the detection of local recurrence in the case of rectal cancer, as well as the place of CT colonography and fecal tests in post-CRC surveillance.

Section snippets

Literature Review

The English-language medical literature was searched using MEDLINE (2005 to September 30, 2015), EMBASE (2005 to September 30, 2015), the Database of Abstracts of Reviews and Effects (2005 to October 7, 2015), and the Cochrane Database of Systematic Reviews (2005 to October 7, 2015). In MEDLINE, subject headings for colorectal neoplasms were combined with the subheading for surgery, resection, postoperative, colectomy, curative, survivor, survival, neoplasm recurrence, second primary neoplasms,

Effect of Surveillance Colonoscopy on Survival

Observational studies utilizing large administrative databases10, 11, 12 and meta-analysis of randomized controlled trials (RCTs)13, 14 show that patients who receive surveillance colonoscopy after CRC resection have lower overall,10, 11, 12, 13, 14 but not disease-specific11, 14 mortality. Cancer-specific mortality is considered the most important outcome in cancer trials.15 Possible explanations for the discrepancies between all-cause and CRC-specific mortality are unmeasured comorbidity

Colonoscopy and Perioperative Clearing in Patients With Cancer of the Colon or Rectum

The critical importance of a complete high-quality colonoscopy to exclude synchronous tumors and find and resect polyps in patients with CRC cannot be overemphasized. In patients with CRC, the prevalence of synchronous cancers ranges from 0.7% % to about 7%.39, 40, 41, 42, 43, 44, 45, 46, 47, 48 Colonoscopy is preferably performed preoperatively49; however, it can be deferred for 3 to 6 months postoperatively if colonoscopy is incomplete due to malignant obstruction. The 3-month lower limit is

Colonoscopy and Prevention of Metachronous Cancer After Surgery for Colon and for Rectal Cancer

Colonoscopy is the procedure of choice for the detection of intraluminal metachronous CRCs. Pooled data from studies selected for this review (Supplementary Tables 1 and 2) show that approximately two-thirds of metachronous cancers are asymptomatic, TNM stage I or II (or Dukes stage A or B), and reoperated with curative intent. Data from population-based registries suggest that metachronous CRCs are being diagnosed at earlier stages, possibly reflecting the effect of increased surveillance.48,

Additional Considerations in Surveillance of Rectal Cancer

An important distinction is made between colon and rectal cancer because of the latter’s higher propensity for local recurrence. In the studies compiled for this review that reported on colon and rectal cancer separately, >80% of anastomotic recurrences involved patients with cancer of the rectum or distal colon.18, 20, 26, 39, 40, 41, 44, 76, 89 In the RCT by Wang et al,26 recurrent cancers diagnosed in the colon had higher resectability than rectal malignancies. The local recurrence rate of

Acknowledgments

The authors thank Kellie Kaneshiro, AMLS, AHIP (Research Informationist, Indiana University School of Medicine) for her expert help with the literature search.

The views and opinions of authors expressed herein do not necessarily state or reflect those of the United States Government or the Department of Veterans Affairs.

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    This article is being published jointly in Gastroenterology, American Journal of Gastroenterology, and Gastrointestinal Endoscopy.

    Conflicts of interest The authors disclose no conflicts.

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