February 25, 2019
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CRC risk remains high after curative resection

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Patients who undergo curative surgery for colorectal cancer remain at relatively high risk for cancer although the quality of surveillance colonoscopies remain high, according to results of a retrospective cohort.

Anne-Marie van Berkel, of the department of gastroenterology and hepatology at Noordwest Ziekenhuisgroep in the Netherlands, and colleagues wrote that although endoscopic surveillance after resection is routine in clinical practice, there is limited research on the right timing for the first exam after surgery.

“Until date, there are no trials that have established the optimal interval in a randomized controlled design,” they wrote. “This has led to different guideline recommendations on surveillance intervals, varying from one to five years after curative resection.”

Researchers performed a retrospective cohort study of 572 patients who underwent curative resection of a first CRC in the northwest of the Netherlands from 2013 to 2016. They included patients who underwent a complete clearing colonoscopy before surgery and if the interval between pre- and postoperative colonoscopy was 12 months.

The primary outcome was yield of CRC at the surveillance colonoscopy performed one year after resection, and the secondary outcome was the yield of advanced neoplasia.

After a mean surveillance interval of 13.7 months (±2.8 months), 10 patients were diagnosed with CRC (1.7%; 95% CI, 0.7–2.8). Half of the cancers were metachronous, while the other half were recurrent.

Investigators determined that surveillance colonoscopies detected advanced neoplasia in 11.4% of patients (95% CI, 8.9–13.8), and synchronous advanced neoplasia at baseline colonoscopy was a risk factor for detection of advanced neoplasia at follow-up (OR = 2.2; 95% CI, 1.3–3.8).

Although colonoscopy remains the gold standard, van Berkel and colleagues wrote that lesions are still missed, and those missed lesions account for a large proton of post-colonoscopy CRC.

“The high yield of 1.7% CRCs justifies the recommendation of a 1-year surveillance interval,” they wrote. “Future research should further investigate the procedural and biological factors responsible for this finding, as to optimize the effectiveness of the post-CRC surveillance program.” – by Alex Young

Disclosures: Van Berkel reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.

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