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Should colonoscopy be performed one year out from colorectal cancer resection?

Should colonoscopy be performed one year out from colorectal cancer resection?. Newcastle NHS Trust. Alexandra Kent, Philip Thompson, Prof Alan Horgan, Mr Paul Hainsworth. ACPGBI: Guidelines for the Management of Colorectal Cancer.

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Should colonoscopy be performed one year out from colorectal cancer resection?

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  1. Should colonoscopy be performed one year out from colorectal cancer resection? Newcastle NHS Trust Alexandra Kent, Philip Thompson, Prof Alan Horgan, Mr Paul Hainsworth

  2. ACPGBI: Guidelines for the Management of Colorectal Cancer Staging investigation for potentially curable colorectal cancer • Complete visualisation of colon required either pre- or post-operatively. • If complete colonic imaging is not possible before surgery, it is important this is done within six months, or as soon as possible after closure of a temporary ileostomy.

  3. ACPGBI Guidelines Colonoscopic follow-up • If such a policy is pursued, it is recommended that a “clean” colon should be examined by colonoscopy at 5 yearly intervals. • Patients should be counselled about the potential complications of colonoscopy. ACPGBI. Guidelines for the management of colorectal cancer 3rd edition 2007.

  4. NICE guidelines (2004) • Patients who did not have a complete colonoscopy pre-op should be offered colonoscopy within 6 months of discharge. • MDTs in each network should agree follow up guidelines. • 5 yearly intervals for patients with a ‘clean’ colon. NICE. Guidance on cancer services. Improving outcomes in colorectal cancer. 2004.

  5. NICE guidelines (2011) • Offer a surveillance colonoscopy at 1 year after initial treatment. If this is normal consider colonoscopy at 5 years. • Two Systematic reviews - potential benefit in identifying recurrence of disease at an earlier stage - Low-moderate evidence base. NICE. CG131 Colorectal cancer - the diagnosis and management of colorectal cancer 2011 Jeffery M, Hickey BE, Hider PN. Follow-up strategies for patients treated for non-metastatic colorectal cancer (Review), The Cochrane Library 2007, Issue 4 Tiandra J, Chan MK..Follow-up after curative resection of colorectal cancer: a meta-analysis. Dis Colon Rectum. 2007 Nov;50(11):1783-99

  6. Newcastle Colorectal MDT Guidelines Patients undergoing curative resection. • Complete colonoscopy pre-operatively or within 6 months of discharge • Surveillance colonoscopy at 1 year

  7. AimsTo assess compliance with local guidelines in patients undergoing curative colorectal cancer resection: • Complete colonoscopy pre-op or within 6 months • Follow up colonoscopy at one year • Incidence of synchronous / metachronous lesions • Record interventions resulting from colonoscopy

  8. Method • Colorectal cancer resections 2008-2012 PJH/AFH (total=347) • Sub-set selected commencing 2008 • Retrospective electronic chart review • Endoscopy database • Endoscopic outcomes recorded

  9. Sample • 115 patients • 53 female, 62 male • Age range 39-92, median 71 • Dukes A 23; B 33; C39; D20.

  10. Resections performed Other: - 1 pelvic exanteration and 1 enbloc resection

  11. Complete colonoscopy pre-op or by 6 months

  12. Completion colonoscopy

  13. Patients eligible for 1 year follow up colonoscopy

  14. 60/ 88 patients had surveillance colonoscopy 28 eligible patients did not have colonoscopies Reasons for failure to perform 1 year follow up colonoscopy

  15. Timing of ‘1 year’ colonoscopy Range 6-30 months post-op

  16. Incidence of metachronous lesions at ‘1 year’ scope (n=60) • Normal 35 • Polyps 24 • 1 patient had a TEMS procedure, local reoccurrence at 17 months on colonoscopy - anterior resection

  17. Interventions and complicationsresulting from colonoscopy • 24 patients cleared of polyps • 1 vasovagal episode - delayed discharge

  18. Surveillance Polyps (24 patients)

  19. Conclusion • Failure to establish clean colon within 6 months • 1 year colonoscopy performed in 68% range 6 - 30 months • Significant incidence of lesions leading to interventions in 24 • Low complication rate from colonoscopy

  20. DiscussionShould colonoscopy be performed one year out from colorectal cancer resection? Benefits • Ensures clean colon in patients missed by pre-op/ 6month colonoscopy. • Acknowledged aversion to removing polyps by surgeons when suspected cancer discovered • Drawbacks • Cost • Invasive Procedure • Limitations • Small study size • Missing data

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