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 19 February 2018

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News

CT colonography vs optical colonoscopy to evaluate surgical anastomosis at colorectal cancer surveillance

The latest issue of the Diseases of the Colon & Rectum reports on a prospective trial comparing colorectal surveillance techniques that evaluated the surgical anastomosis at 1-year.

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Dr Perry Pickhardt and colleagues compared the accuracy of CT colonography versus optical colonoscopy for neoplastic involvement at the surgical anastomosis 1 year after curative-intent colorectal cancer resection.

The team reported that 201 patients underwent same-day contrast-enhanced CT colonography and colonoscopy approximately 1 year after colorectal cancer resection as part of a prospective, multicenter trial.

All patients enrolled were without clinical evidence of disease and considered low risk for recurrence.

The main outcomes were suspected neoplastic lesions within 5 cm of the colonic anastomosis were recorded at CT colonography, with subsequent colonoscopy performed for the same, with segmental unblinding of colonography findings.

Anastomotic region biopsy or polypectomy was performed at the endoscopist’s discretion.

Only 1% of patients were called positive at CT colonography for intraluminal anastomotic nondiminutive lesions
Diseases of the Colon & Rectum

None of the 201 patients had intraluminal anastomotic cancer recurrence or advanced neoplasia.

CT colonography detected extramural perianastomotic recurrence in 1% of patients, and were not detected at colonoscopy.

The reported that only 1% of patients were called positive at CT colonography for intraluminal anastomotic nondiminutive lesions, which were confirmed at colonoscopy but nonneoplastic at histopathology.

At optical colonoscopy, the anastomosis was deemed abnormal and/or biopsied in 10%, yielding only 1 nondiminutive benign neoplasm.

Dr Pickhardt's team concludes, "Relevant intraluminal anastomotic pathology appears to be very uncommon 1 year after colorectal cancer resection in lower-risk cohorts."

"Unlike colonoscopy, diagnostic contrast-enhanced CT colonography effectively evaluates both the intra- and extraluminal aspects of the anastomosis."

Dis Colon Rectum 2017: 60(11): 1162–1167
19 October 2017

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