Lorenzo Fuccio1, Douglas Rex2, Thierry Ponchon3, Leonardo Frazzoni4, Mário Dinis-Ribeiro5, Pradeep Bhandari6, Evelien Dekker7, Maria Pellisè8, Loredana Correale4, Jeanin van Hooft7, Rodrigo Jover9, Diogo Libanio5, Franco Radaelli10, Sergio Alfieri11, Franco Bazzoli4, Carlo Senore12, Jaroslaw Regula13, Thomas Seufferlein14, Thomas Rösch15, Prateek Sharma16, Alessandro Repici17, Cesare Hassan17. 1. Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. Electronic address: lorenzofuccio@gmail.com. 2. Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana. 3. Gastroenterology and Endoscopy, Edouard Herriot Hospital, Lyon, France. 4. Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. 5. Ciências da Informação e Decisão em Saúde (CIDES)/Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS) Faculty of Medicine, University of Porto, Porto, Portugal. 6. Queen Alexandra Hospital, Cosham, Portsmouth, UK. 7. Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 8. Gastroenterology Department, Endoscopy Unit, Clínic Institute of Digestive and Metabolic Diseases, Hospital Clinic, Biomedical Research Networking Center in Hepatic and Digestive Diseases, The August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Catalonia, Spain. 9. Service of Digestive Medicine, Instituto de Investigación Sanitaria y Biomédica de Alicante-Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana Foundation, Alicante, Spain. 10. Department of Gastroenterology, Valduce Hospital, Como, Italy. 11. Digestive Surgery Department, Catholic University of Sacred Heart, Rome, Italy. 12. Azienda Ospedaliero Universitaria Cittá della Salute e della Scienza Centro per l'Epidemiologia e la Prevenzione Oncologica in Piemonte, Turin, Italy. 13. The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland. 14. Klinik für Innere Medizin, Universitätsklinikum Ulm, Ulm, Germany. 15. Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 16. Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Missouri. 17. Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research and University Hospital, Rozzano, Italy.
Abstract
BACKGROUND & AIMS: Outcomes of endoscopic surveillance after surgery for colorectal cancer (CRC) vary with the incidence and timing of CRC detection at anastomoses or non-anastomoses in the colorectum. We performed a systematic review and meta-analysis to evaluate the incidence of CRCs identified during surveillance colonoscopies of patients who have already undergone surgery for this cancer. METHODS: We searched PubMed, EMBASE, SCOPUS, and the Cochrane Central Register of Clinical Trials through January 1, 2018 to identify studies investigating rates of CRCs at anastomoses or other locations in the colorectum after curative surgery for primary CRC. We collected data from published randomized controlled, prospective, and retrospective cohort studies. Data were analyzed by multivariate meta-analytic models. RESULTS: From 2373 citations, we selected 27 studies with data on 15,803 index CRCs for analysis (89% of patients with stage I-III CRC). Overall, 296 CRCs at non-anastomotic locations were reported over time periods of more than 16 years (cumulative incidence, 2.2% of CRCs; 95% confidence interval [CI], 1.8%-2.9%). The risk of CRC at a non-anastomotic location was significantly reduced more than 36 months after resection compared with before this time point (odds ratio for non-anastomotic CRCs at 36-48 months vs 6-12 months after surgery, 0.61; 95% CI, 0.37-0.98; P = .031); 53.7% of all non-anastomotic CRCs were detected within 36 months of surgery. One hundred and fifty-eight CRCs were detected at anastomoses (cumulative incidence of 2.7%; 95% CI, 1.9%-3.9%). The risk of CRCs at anastomoses was significantly lower 24 months after resection than before (odds ratio for CRCs at anastomoses at 25-36 months after surgery vs 6-12 months, 0.56; 95% CI, 0.32-0.98; P = .036); 90.8% of all CRCs at anastomoses were detected within 36 months of surgery. CONCLUSIONS: After surgery for CRC, the highest risk of CRCs at anastomoses and at other locations in the colorectum is highest during 36 months after surgery-risk decreases thereafter. Patients who have undergone CRC resection should be evaluated by colonoscopy more closely during this time period. Longer intervals may be considered thereafter.
BACKGROUND & AIMS: Outcomes of endoscopic surveillance after surgery for colorectal cancer (CRC) vary with the incidence and timing of CRC detection at anastomoses or non-anastomoses in the colorectum. We performed a systematic review and meta-analysis to evaluate the incidence of CRCs identified during surveillance colonoscopies of patients who have already undergone surgery for this cancer. METHODS: We searched PubMed, EMBASE, SCOPUS, and the Cochrane Central Register of Clinical Trials through January 1, 2018 to identify studies investigating rates of CRCs at anastomoses or other locations in the colorectum after curative surgery for primary CRC. We collected data from published randomized controlled, prospective, and retrospective cohort studies. Data were analyzed by multivariate meta-analytic models. RESULTS: From 2373 citations, we selected 27 studies with data on 15,803 index CRCs for analysis (89% of patients with stage I-III CRC). Overall, 296 CRCs at non-anastomotic locations were reported over time periods of more than 16 years (cumulative incidence, 2.2% of CRCs; 95% confidence interval [CI], 1.8%-2.9%). The risk of CRC at a non-anastomotic location was significantly reduced more than 36 months after resection compared with before this time point (odds ratio for non-anastomotic CRCs at 36-48 months vs 6-12 months after surgery, 0.61; 95% CI, 0.37-0.98; P = .031); 53.7% of all non-anastomotic CRCs were detected within 36 months of surgery. One hundred and fifty-eight CRCs were detected at anastomoses (cumulative incidence of 2.7%; 95% CI, 1.9%-3.9%). The risk of CRCs at anastomoses was significantly lower 24 months after resection than before (odds ratio for CRCs at anastomoses at 25-36 months after surgery vs 6-12 months, 0.56; 95% CI, 0.32-0.98; P = .036); 90.8% of all CRCs at anastomoses were detected within 36 months of surgery. CONCLUSIONS: After surgery for CRC, the highest risk of CRCs at anastomoses and at other locations in the colorectum is highest during 36 months after surgery-risk decreases thereafter. Patients who have undergone CRC resection should be evaluated by colonoscopy more closely during this time period. Longer intervals may be considered thereafter.
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
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