Chantal M C le Clercq1, Bjorn Winkens2, C Minke Bakker3, Eric T P Keulen4, Geerard L Beets5, Ad A M Masclee6, Silvia Sanduleanu1. 1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands; GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands. 2. Department of Methodology and Statistics, Maastricht University Medical Center, Maastricht, The Netherlands; CAPHRI, School for Public Health and Primary Care, Maastricht University Medical Center, Maastricht, The Netherlands. 3. Department of Internal Medicine and Gastroenterology, Atrium Medical Center Heerlen, Heerlen, The Netherlands. 4. Department of Internal Medicine and Gastroenterology, Orbis Medical Center Sittard, Sittard, The Netherlands. 5. GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands. 6. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands; NUTRIM, School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands.
Abstract
BACKGROUND: Several studies examined the rate of colorectal cancer (CRC) developed during colonoscopy surveillance after CRC resection (ie, metachronous CRC [mCRC]), yet the underlying etiology is unclear. OBJECTIVE: To examine the rate and likely etiology of mCRCs. DESIGN: Population-based, multicenter study. Review of clinical and histopathologic records, including data of the national pathology database and The Netherlands Cancer Registry. SETTING: National cancer databases reviewed at 3 hospitals in South-Limburg, The Netherlands. PATIENTS: Total CRC population diagnosed in South-Limburg from January 2001 to December 2010. INTERVENTIONS: Colonoscopy. MAIN OUTCOME MEASUREMENTS: We defined an mCRC as a second primary CRC, diagnosed >6 months after the primary CRC. By using a modified algorithm to ascribe likely etiology, we classified the mCRCs into cancers caused by non-compliance with surveillance recommendations, inadequate examination, incomplete resection of precursor lesions (CRC in same segment as previous advanced adenoma), missed lesions, or newly developed cancers. RESULTS: We included a total of 5157 patients with CRC, of whom 93 (1.8%) had mCRCs, which were diagnosed on an average of 81 months (range 7-356 months) after the initial CRC diagnosis. Of all mCRCs, 43.0% were attributable to non-compliance with surveillance advice, 43.0% to missed lesions, 5.4% to incompletely resected lesions, 5.4% to newly developed cancers, and 3.2% to inadequate examination. Age-adjusted and sex-adjusted logistic regression analyses showed that mCRCs were significantly smaller in size (odds ratio [OR] 0.8; 95% confidence interval [CI], 0.7-0.9) and more often poorly differentiated (OR 1.7; 95% CI, 1.0-2.8) than were solitary CRCs. LIMITATIONS: Retrospective evaluation of clinical data. CONCLUSION: In this study, 1.8% of all patients with CRC developed mCRCs, and the vast majority were attributable to missed lesions or non-compliance with surveillance advice. Our findings underscore the importance of high-quality colonoscopy to maximize the benefit of post-CRC surveillance.
BACKGROUND: Several studies examined the rate of colorectal cancer (CRC) developed during colonoscopy surveillance after CRC resection (ie, metachronous CRC [mCRC]), yet the underlying etiology is unclear. OBJECTIVE: To examine the rate and likely etiology of mCRCs. DESIGN: Population-based, multicenter study. Review of clinical and histopathologic records, including data of the national pathology database and The Netherlands Cancer Registry. SETTING: National cancer databases reviewed at 3 hospitals in South-Limburg, The Netherlands. PATIENTS: Total CRC population diagnosed in South-Limburg from January 2001 to December 2010. INTERVENTIONS: Colonoscopy. MAIN OUTCOME MEASUREMENTS: We defined an mCRC as a second primary CRC, diagnosed >6 months after the primary CRC. By using a modified algorithm to ascribe likely etiology, we classified the mCRCs into cancers caused by non-compliance with surveillance recommendations, inadequate examination, incomplete resection of precursor lesions (CRC in same segment as previous advanced adenoma), missed lesions, or newly developed cancers. RESULTS: We included a total of 5157 patients with CRC, of whom 93 (1.8%) had mCRCs, which were diagnosed on an average of 81 months (range 7-356 months) after the initial CRC diagnosis. Of all mCRCs, 43.0% were attributable to non-compliance with surveillance advice, 43.0% to missed lesions, 5.4% to incompletely resected lesions, 5.4% to newly developed cancers, and 3.2% to inadequate examination. Age-adjusted and sex-adjusted logistic regression analyses showed that mCRCs were significantly smaller in size (odds ratio [OR] 0.8; 95% confidence interval [CI], 0.7-0.9) and more often poorly differentiated (OR 1.7; 95% CI, 1.0-2.8) than were solitary CRCs. LIMITATIONS: Retrospective evaluation of clinical data. CONCLUSION: In this study, 1.8% of all patients with CRC developed mCRCs, and the vast majority were attributable to missed lesions or non-compliance with surveillance advice. Our findings underscore the importance of high-quality colonoscopy to maximize the benefit of post-CRC surveillance.
Authors: Charles J Kahi; C Richard Boland; Jason A Dominitz; Francis M Giardiello; David A Johnson; Tonya Kaltenbach; David Lieberman; Theodore R Levin; Douglas J Robertson; Douglas K Rex Journal: Am J Gastroenterol Date: 2016-02-12 Impact factor: 10.864
Authors: Ervin Toth; Diana E Yung; Artur Nemeth; Gabriele Wurm Johansson; Henrik Thorlacius; Anastasios Koulaouzidis Journal: Ann Transl Med Date: 2017-05
Authors: Ernst J Kuipers; William M Grady; David Lieberman; Thomas Seufferlein; Joseph J Sung; Petra G Boelens; Cornelis J H van de Velde; Toshiaki Watanabe Journal: Nat Rev Dis Primers Date: 2015-11-05 Impact factor: 52.329
Authors: Jae Hyun Kim; Youn Jung Choi; Hye Jung Kwon; Seun Ja Park; Moo In Park; Won Moon; Sung Eun Kim Journal: World J Gastroenterol Date: 2015-08-21 Impact factor: 5.742
Authors: Bishnu P Joshi; Juan Zhou; Asha Pant; Xiyu Duan; Quan Zhou; Rork Kuick; Scott R Owens; Henry Appelman; Thomas D Wang Journal: Bioconjug Chem Date: 2015-12-28 Impact factor: 4.774
Authors: Kevin J Monahan; Nicola Bradshaw; Sunil Dolwani; Bianca Desouza; Malcolm G Dunlop; James E East; Mohammad Ilyas; Asha Kaur; Fiona Lalloo; Andrew Latchford; Matthew D Rutter; Ian Tomlinson; Huw J W Thomas; James Hill Journal: Gut Date: 2019-11-28 Impact factor: 23.059
Authors: Matthew D Rutter; James East; Colin J Rees; Neil Cripps; James Docherty; Sunil Dolwani; Philip V Kaye; Kevin J Monahan; Marco R Novelli; Andrew Plumb; Brian P Saunders; Siwan Thomas-Gibson; Damian J M Tolan; Sophie Whyte; Stewart Bonnington; Alison Scope; Ruth Wong; Barbara Hibbert; John Marsh; Billie Moores; Amanda Cross; Linda Sharp Journal: Gut Date: 2019-11-27 Impact factor: 31.793