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Timing of colonoscopy after colorectal cancer resection - are we looking too soon?

A study in the latest issue of the Diseases of the Colon & Rectum determined whether the incidence of cancer or advanced polyp detection rate was high enough to justify colonoscopy at 1 year.

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Based on current National Comprehensive Cancer Network guidelines, colonoscopic surveillance after colorectal cancer resection should begin at 1 year.

Dr Cone and colleagues determined whether the incidence of cancer or advanced polyp detection rate was high enough to justify colonoscopy at 1 year.

The Ochsner Clinic Tumor Registry Database was queried for patients who underwent a segmental colectomy or proctectomy between 2002 and 2010.

Patients who had a preoperative colonoscopy and at least 1 documented postoperative colonoscopy were included.

The research team considered new cancer or polyps of ≥1 cm as missed on the preoperative colonoscopy.

Patients with an identified genetic trait causing a predisposition to colorectal cancer were excluded.

There were 33% with stage I disease
Diseases of the Colon & Rectum

The research team reported that 512 patients underwent resection, and 155 met their inclusion criteria.

The average age was 64 years, and 53% patients were male.

There were 33% with stage I disease, 35% with stage II disease, 27% with stage III disease, and 5% with stage IV disease.

Of these patients, 52% had a right colectomy, 7% had a left colectomy, 17% had a sigmoid colectomy, 22% had a low anterior resection, and 1% had a transanal resection.

The researchers noted that the average time to first postoperative colonoscopy was 478 days.

The research team noted that 24 patients had adenomatous polyps detected on their first surveillance colonoscopy, but only 5 polyps were ≥1 cm.

The team observed no correlation between stage of cancer and finding a polyp.

No new cancers were detected, but 3 had an anastomotic recurrence.

Dr Cone's team concludes, "The performance of surveillance colonoscopy at 1 year resulted in the detection of only 5 missed polyps ≥1 cm and no metachronous cancers."

"Anastomotic recurrences were rare, and the majority were in patients who had rectal cancer that could be evaluated by in-office flexible sigmoidoscopy."

"Extending the time to first colonoscopy appears to be safe and would help conserve valuable resources, including physician and facility time, which is imperative in the current health care climate."

Dis Colon Rectum 2013: 56(11): 1233–1236
07 November 2013

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