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