What Is the Compliance with Recommended Guidelines for Endoscopic Surveillance After Colon Cancer Resection?

INTRODUCTION: In 2006, the American Cancer Society and the US Multi-Society Task Force on Colorectal Cancer issued a consensus statement on the use of surveillance colonoscopy after colectomy for colorectal cancer. It was recommended that patients undergo surveillance colonoscopy one year after curative resection. The aim of this study was to assess the compliance with the 2006 consensus statement guidelines for surveillance colonoscopy after curative resection of colorectal cancer in a tertiary academic medical center.
METHODS: IRB approved review of prospectively collected data on all patients undergoing colectomy for colon cancer between 1998 and 2008 at a large teaching institution was conducted. Patients who underwent a palliative procedure or were found to have benign disease on pathology were excluded from the study. Demographic information, post-operative colonoscopy findings, and pathology data were collected and analyzed.
RESULTS: Over the ten year period 206 patients underwent colectomy for colon cancer. Twenty-eight patients were excluded for having metastatic disease, or due to patient refusal. Of the remaining 178 patients, 148 (83.1%) underwent surveillance colonoscopy postoperatively; eighty of these patients (54.1%) had their colonoscopy within 12 months after resection, and 117 (79.1%) within 24 months after resection. The mean interval between colon cancer resection and initial surveillance colonoscopy was 22.9 months (range 2-123). 73 patients (68.2%) had either negative or benign pathologic findings (hyperplastic polyps, benign mucosa, or inflammatory reaction), 29 patients (27.1%) had adenomatous disease, 3 (2.8%) had recurrent malignant disease, and 2 (1.9%) had anastomotic stricture requiring intervention. Recurrent malignant disease was detected at 24, 81, and 98 months and none of these patients had received surveillance colonoscopy at 12 months.
CONCLUSION: We found limited compliance with recommended guidelines for surveillance colonoscopy one year after curative resection for colorectal cancer. The recurrences detected in our study population might have been detected earlier had patients undergone their colonoscopy at the recommended postoperative interval. Since earlier recurrence detection might lead to improved survival, our findings suggest that measures to improve patient and physician compliance with post-resection colonoscopy are needed.

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Program Number: P161

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