Colonoscopic surveillance after curative colorectal resection: Results of an empirical surveillance programme

Introduction Colonoscopic surveillance after colorectal cancer resection is widely practised despite little evidence that it improves survival. The optimum protocol for colonoscopic follow‐up after colorectal cancer resection has not yet been elucidated. We audited the outcome of an empirical colonoscopic follow‐up programme in a cohort of patients who underwent colorectal resection with a minimum of five years follow‐up to establish patterns of metachronous neoplasia and suitable surveillance intervals. Methods The colonoscopic records, biopsy results and follow‐up details of patients diagnosed with colorectal cancer between June1990 and June1996 were reviewed. The number and type of metachronous neoplastic lesions diagnosed was recorded. Rates of development of new neoplasms were estimated by calculating the time from operation to their first discovery. Factors predictive of further development of polyps or cancer were sought. Results were compared to published reports of intensive follow‐up programmes. Results Seven hundred and ninety‐eight patients underwent colorectal resection with curative intent during the study period. 226 patients had one or more follow‐up colonoscopies (mean time post resection 48.8 months). In total 352 colonoscopies, encompassing 1437 patient years of surveillance, were performed. Nine metachronous cancers in eight patients, five of which were asymptomatic were diagnosed by colonoscopy at a mean of 63 months. Three asymptomatic recurrences were diagnosed but all were inoperable. 70 (31%) patients had adenomatous polyps diagnosed after a mean time from operation of 34 months for simple adenomatous polyps and 21 months for those with advanced features. Patients with multiple polyps or advanced polyps at the initial colonoscopy were more likely to form subsequent polyps. Only 5.8% of patients with a single adenoma or a normal colon formed an advanced adenoma over the next 36 months of surveillance. Conclusion The results of an empirical colonoscopic follow‐up programme compared favourably to the results of the intensive programmes reported in the literature. Most patients are at very low risk of developing significant colonic pathology over the first five years after resection. Colonoscopic surveillance intervals need not be less than five years unless the patient has multiple adenomas or advanced adenomas at the first colonoscopy. Three yearly surveillance intervals are most probably adequate in these individuals.     

Effect of preoperative colonoscopy on the incidence of synchronous and metachronous neoplasms

Colonoscopy and air-contrast barium enema performed preoperatively in 389 patients with colorectal cancer revealed synchronous cancer in 4% and polyp in 14%. Nine of the 16 synchronous cancers were located in other surgical segments than the index cancer, and six of the nine were in stage A or B1. Of the 54 synchronous polyps, 28 were located in such other segments. Half of the synchronous cancers and almost half of the synchronous polyps were missed at double-contrast barium enema. All synchronous cancers and three-fourths of the synchronous polyps were detected at colonoscopy. No patient with preoperative colonoscopy presented with metachronous cancer within 3 years from surgery, and only two were subsequently found to have adenocarcinoma arising from an adenomatous polyp. Endoscopic polypectomy was performed in 21 cases during follow-up. Extensive use of preoperative colonoscopy is recommended in the evaluation of colorectal cancer, in order to promote detection of synchronous tumors, reduce the incidence of 'early metachronous' cancer and avoid malignant degeneration of adenomatous polyp.     

Timing and detection of metachronous colorectal cancer

Background: Surveillance following surgery for colorectal cancer aims to detect treatable disease relapse or metachronous neoplasia. Metachronous cancers have been reported within a short duration of follow‐up, and may be due to missed lesions, seeding into polypectomy wounds or accelerated tumorigenesis related to genetic instability. The purpose of this study was to establish the timing and method of detection of metachronous cancers in a large population of patients in a surveillance database. Methods: This retrospective clinical study used patients with an elevated risk of colorectal neoplasia included in a colonoscopy‐based surveillance programme to identify those with two or more colorectal cancers, as well as the timing and method of detection of the tumours. Colonoscopy reports and histopathology results were reviewed to determine quality of bowel preparation, tumour location, and polypectomy data. Results: Fourteen (2.5%) of 569 patients with colorectal cancer developed metachronous malignant tumours, nearly half of which were identified within 3 years of follow‐up by surveillance colonoscopy or an interval faecal immunochemical test for globin. None of these had a previous polypectomy at the site of the second tumour, bowel preparation at the original colonoscopy was good in most cases, and no metachronous tumour occurred at a colonic flexure. Conclusion: Metachronous cancers can occur early during follow‐up after curative intent resection, and early colonoscopic surveillance may be warranted.     

What is achieved by mammographic surveillance after breast conservation treatment for breast cancer?

BACKGROUND: Hereditary nonpolyposis colorectal cancer (HNPCC) accounts for approximately 2% to 5% of all colorectal cancers. Rectal cancer in HNPCC is not well characterized. METHODS: A retrospective medical record review of HNPCC patients with colorectal cancer diagnosis from December 1948 to December 1999 was performed in an attempt to elucidate the natural history of rectal cancer in HNPCC. Group A consisted of patients diagnosed with rectal cancer as the index colorectal cancer. Group B consisted of patients diagnosed with rectal cancer as a metachronous colorectal cancer. RESULTS: Twenty-five of 104 patients developed rectal cancer in our HNPCC registry. There were 18 patients in group A with a median age at diagnosis of rectal cancer of 48 years (range 24 to 79) and 7 patients in group B diagnosed at a median age of 58 years (range 45 to 68). Three of 18 patients (17%) in group A developed metachronous colon cancers at a median of 203 months (range 27 to 373) from the index rectal cancer. Rectal cancer in group B was diagnosed at a median 245 months (range 51 to 564) from the index colorectal cancer diagnosis. CONCLUSIONS: Rectal cancer in HNPCC is not uncommon. The presentation of rectal carcinoma should not obviate the evaluation for HNPCC in suspected cases.     

The mechanism of microsatellite instability is different in synchronous and metachronous colorectal cancer

MLH1 promoter hypermethylation has been described as the primary mechanism for high-frequency microsatellite instability (MSI-H) in sporadic colorectal cancers (CRCs). The underlying molecular mechanism for microsatellite instability (MSI) in synchronous and metachronous CRCs is not well described. A total of 33 metachronous CRC patients and 77 synchronous CRC patients were identified from 2884 consecutive patients undergoing cancer surgery in an academic center. Evaluable tumors were tested for MSI, immunohistochemistry for MLH1 and MSH2 protein expression, and hypermethylation of the MLH1 promoter. MSI-H tumors were found in 12 (36%) metachronous CRC patients and 29 (38%) synchronous CRC patients. MSI-H metachronous CRC patients were younger at index cancer diagnosis (64 vs. 76 years, P = 0.01) and more often were diagnosed before 50 years of age (4 of 12 vs. 0 of 29, P = 0.005). Loss of MLH1 expression associated with promoter hypermethylation was common in all patients, although more common in MSI-H synchronous patients (50% metachronous vs. 83% synchronous, P = 0.03). Overall, MLH1 promoter hypermethylation was seen in 7 of 17 (41%) metachronous and 44 of 54 (81%) synchronous MSI-H CRCs tested (P = 0.004). Although MSI occurred with equal frequency among patients with synchronous and metachronous CRCs, the underlying mechanism for MSI was different. Observed differences in MLH1 promoter hypermethylation and patient characteristics suggest most MSI-H synchronous CRCs in our population were sporadic in origin. In contrast, more MSI-H metachronous CRCs were associated with patient and tumor characteristics suggestive of underlying hereditary nonpolyposis CRC. Presented as a poster at Digestive Disease Week 2001, Atlanta, Georgia, May 20–23, 2001.     

The impact of temporal presentation on clinical and pathological outcomes for patients with sporadic bilateral renal masses

BACKGROUND: The origin of bilateral renal masses has not been definitively established to date. As limited studies on the genetics of bilateral tumors exist, defining the clinical behavior of these lesions remains important. OBJECTIVE: To evaluate the impact of synchronous versus metachronous presentation on clinicopathological outcomes of patients with bilateral renal masses. DESIGN, SETTING, AND PARTICIPANTS: We identified 310 patients who were treated at the Mayo Clinic for sporadic bilateral renal masses between 1970-2003, including 148 (47.7%) with synchronous tumors and 162 (52.3%) with metachronous lesions. INTERVENTION: Patients underwent surgical resection of bilateral renal tumors. MEASUREMENTS: Clinicopathological features of synchronous and metachronous tumors were compared. Survival rates for patients with synchronous (n=92) and metachronous (n=100) renal cell carcinoma (RCC) were estimated using the Kaplan-Meier method and compared with the log rank test. RESULTS AND LIMITATIONS: Metachronous tumors had a greater degree of pathological concordance than synchronous lesions, with 87.7% of metachronous tumors representing bilateral RCC, compared to 69.2% of synchronous masses (p=0.002). Patients with synchronous RCC tended to have an increased incidence of papillary RCC compared to patients with metachronous RCC, who were more likely to have bilateral clear-cell RCC (p=0.076). A longer interval between tumors was inversely associated with the risk of cancer death for patients with metachronous RCC (HR 0.90, 95% CI 0.81-0.99, p=0.039). Compared to patients with metachronous RCC, patients with synchronous bilateral RCC had similar 10-yr CSS (70.5% vs. 69.4%, p=0.51) and OS (47.5% vs. 51.2%, p=0.58). We nevertheless recognize that these findings may be limited by the study's retrospective, single-institution design. CONCLUSIONS: Metachronous bilateral solid renal masses have a greater degree of pathological concordance and were more likely to represent malignancy. Surgical resection may provide durable cancer control for patients with bilateral RCC, with no difference in survival noted between synchronous and metachronous cancers.     

Peri-operative colonoscopy detects synchronous tumours in patients with colorectal cancers

The aim of this study was to assess the value of colonoscopy as a peri-operative investigation in patients treated for colorectal cancer by surgical excision. Patients (134 male, 83 female) undergoing curative resection for colorectal carcinoma between August 1984 and January 1989 had colonoscopy within 3 months of surgery. Eleven patients (5%) had a synchronous cancer, which was diagnosed by colonoscopy in eight. In six of these eight, the diagnosis was made after surgery and 3 patients needed a second colectomy. However, in 3 patients the synchronous cancer was removed endoscopically without the need for further surgical resection. Most synchronous cancers had an earlier pathological stage than the index tumour. The rate of synchronous cancers was higher in patients with synchronous benign polyps (16%) than in those without polyps (3%). Colonoscopy is clearly justified as a peri-operative investigation in all patients undergoing potentially curative resection of colorectal cancer. If possible, the examination should be carried out prior to surgery, to guide the extent of resection.     

The value of colonoscopic surveillance after curative resection for colorectal cancer or synchronous adenomatous polyps

Between 1975 and 1984, 270 patients underwent a potentially curative resection for colorectal carcinoma. One hundred eighty-eight patients (70%) underwent preoperative colonoscopy, of which 129 patients (69%) were followed up with at least two postoperative colonoscopies. In 91 patients (70%), preoperative colonoscopy revealed no synchronous adenomatous polyps or cancer. Synchronous adenomatous polyps were found in 35 patients (27%), and three patients (2.3%) had a synchronous invasive cancer. Nineteen (54%) of the 35 patients with synchronous adenomatous polyps developed metachronous adenomatous polyps during the follow-up period compared with 24 (26%) of 91 patients without synchronous adenomatous polyps. The median interval to the development of metachronous adenomatous polyps was 19 months, and all of these polyps were 1 cm or less in size. Patients with synchronous adenomatous polyps less than 30 cm from the primary lesion (68%) developed metachronous polyps more often than did patients whose synchronous adenomatous polyps were more than 30 cm from the primary lesion (37%). Preoperative colonoscopy is important for determining synchronous pathology and identifying patients at risk for metachronous polyps.     

Multiple primary lung carcinomas: prognosis and treatment

From 1955 to 1990, 111 patients have been treated for multiple primary lung carcinomas. Criteria for diagnosis were: (1) different histology (n = 44); or (2) same histology, but disease-free interval at least 2 years (n = 39), origin from carcinoma in situ (n = 19), or metachronous disease in different lobe (n = 9) with no cancer in common lymphatics or extrapulmonary metastasis at the time of diagnosis. The second cancer was synchronous in 33 patients (30%) and metachronous in 78 (70%). Metachronous disease developed at a median interval of 48 months. Five-year survival for patients with metachronous and synchronous disease from the time of initial diagnosis of cancer was 70% and 44%, and 10-year survival was 42% and 23%, respectively. Survival after the development of a metachronous lesion was 23% at 5 years. Survival from the time of initial diagnosis was significantly better for metachronous versus synchronous, late (24 month disease-free interval) versus early metachronous disease, and adenocarcinoma versus epidermoid carcinoma. The first cancer was completely resected in 103 patients (93%), but complete resection of a metachronous tumor was possible in only 54 patients (69%). Complete resection of second primary cancers resulted in significantly (p less than 0.0001) prolonged 5-year survival compared with incomplete resection (38% versus 9%). Excluding patients requiring pneumonectomy, initial resection limited subsequent resection in only 7 patients (9%) with metachronous disease. We conclude that patients surviving treatment of primary lung cancers require lifelong screening for multiple primary lung carcinoma, and complete resection is recommended whenever possible.     

19例异时原发结直肠癌的临床特点分析

【摘要】〓目的〓探讨异时原发结直肠癌的临床特点。方法〓回顾性分析2000年~2012年间19例异时原发结直肠癌的临床特点及治疗效果。结果〓我科在2000年~2012年施行1304例结直肠癌根治术的患者中,发现19例异时原发结直肠癌,概率约为1.4%。第二癌出现在首发癌治疗后15到135个月,中位77个月,平均时间为术后74.2±29.5个月。约68.4%的患者(13/19)第2癌发生时间超过5年。与首发癌比较,第2癌体积更小,多发于升结肠。78.6%的患者存在错配修饰基因蛋白表达缺失。5年存活率达100%,全部患者在观察期内均未发现局部复发和血道转移。 结论〓异时原发结直肠癌的发病率较低,错配修饰基因突变率较高,其预后较好。     

Surgical treatment of metachronous colorectal cancers

Thirty-four patients with metachronous colorectal cancer who underwent surgical procedures at the First and Fourth Department of Surgery of the University of Rome were reviewed. 55.9% of the patients developed a second carcinoma within five years after the first operation, and the time interval for the entire group ranged from 13 to 228 months. Adenomatous polyps occurred in 14 patients. Two patients developed a third metachronous cancer. We followed up eight patients using colonoscopy regularly. In this group we found two early cancers, five submucosal cancers and only one advanced tumor. In the other group we found 16 advanced cancers and ten submucosal cancer. The curability rate at second operation was 88.2%, and at the third 50%. The management of metachronous tumors should imply total colonoscopy, at a mean interval of 12-18 months.     

Rationale for aggressive colonoscopy in patients with colorectal neoplasia

The role of colonoscopy in patients with colorectal neoplasia is not well established. The results of colonoscopy, from 1982 through 1987, in 42 patients with cancers who underwent preoperative colonoscopy (group 1), 64 patients with benign polyps (group 2), and 51 patients who were examined only postoperatively (group 3) were reviewed. These results indicated that (1) approximately one third of all findings would have been missed if endoscopy had been performed to only 60 cm; (2) there was a high incidence of synchronous lesions (33.3%) in group 1 and 34.4% in group 2); (3) 57% of patients with synchronous cancer and 63.6% of patients with synchronous polyps developed metachronous lesions, compared with 10.7% and 11.9% of patients with a single lesion; (4) there was a higher incidence of metachronous lesions seen in group 3, compared with group 1; and (5) the median interval for noting metachronous lesions in patients who underwent colonoscopy preoperatively was approximately 18 months. These findings endorsed preoperative colonoscopy and aggressive follow-up in patients with colorectal tumors.     

Recognition and treatment of patients with hereditary nonpolyposis colon cancer (Lynch syndromes I and II).

Primary genetic factors are etiologic in at least 5-10% of patients with colon cancer. The polyposis syndromes (FPC) are easily identified examples because of the spectacular number of polyps. The hereditary nonpolyposis syndromes (HNPCC), although five times more common than FPC, are usually not recognized because they do not have such a distinctive clinical, premonitory genetic marker. Colorectal cancer expression was surveyed in 10 extended, thoroughly documented HNPCC kindreds. One hundred sixteen patients were found to have 183 colorectal cancers. Despite the striking family history, less than 5% were correctly treated by subtotal colectomy. This provided a unique opportunity to study the natural history. Five findings differed significantly (p less than 0.05) from patients with sporadic colon cancer: (1) mean age of initial colon cancer diagnosed was 45.6 years; (2) 69.1% of first colon cancers were located proximal to the splenic flexure of the colon; (3) 18.1% had synchronous colon cancer; (4) 24.2% had metachronous colon cancer develop with life table analysis showing the risk for a metachronous lesion at 10 years to be 40%; and (5) only 23.3% of cancers were located in the sigmoid colon or rectum. Based on this data, it is recommended that the family history of all patients with a newly diagnosed colon cancer be evaluated for evidence of this syndrome. If an autosomal dominant inheritance pattern emerges, an in-depth genetic investigation is indicated. When HNPCC is confirmed, the following recommendations apply: a subtotal abdominal colectomy is indicated at the time of the initial colon cancer because of the risk of synchronous and metachronous lesions. The rectum should be spared in favor of careful lifetime surveillance because of the proclivity for proximal colon cancer involvement. As yet unaffected members of a newly diagnosed HNPCC kindred who are in the "direct genetic line" should be cautioned that they are at 50% risk and must begin an intensive surveillance program beginning in the third decade with careful attention to the right colon. Patients from newly diagnosed HNPCC families who have had a previous conventional colectomy for colon cancer should, at the very least, enter an intensive surveillance program; a prophylactic completion subtotal colectomy should be considered for patients who are less than totally compliant.     

The management of second primary lung cancers. A single centre experience in 15 years.

OBJECTIVE: In patients treated for an initial lung cancer, the cumulative risk of developing a second primary lung cancer is a recognised occurrence. This study reviews our experience in the clinical assessment and surgical management of second primary lung cancer (SPLC). METHODS: Between 1985-1999 a series of 892 patients with primary carcinoma of lung underwent surgical resection with curative intent in our institution. Using criteria set out by Martini and Melamed (J Thorac Cardiovasc Surg 70 (1975) 606) we were able to identify 51 patients who had developed a SPLC identified as the first site of re-occurrence. RESULTS: Forty-one patients developed a metachronous SPLC within a mean of 46+/-14 months of the first operation while ten patients had synchronous double lung cancer (six unilateral, four bilateral). The cumulative probability of cancer free interval for metachronous cancers was 39% at 3 years, 15% at 5 years and 2% at 10 years. There were three postoperative deaths among the metachronous cancers (7.5%) and there were no operative deaths among patients with synchronous cancers. The overall actuarial 5-year survival for all patients with SPLC was 38% with a median survival of 40 months (range 1-142 months). The actuarial 5-year survival for metachronous SPLC was 44%, median survival of 49 months (range 1-142 months), while the actuarial 5-years survival for synchronous SLPC was 10% with a median survival of 31 months (range 4-78 months). CONCLUSION: Aggressive assessment and surgical intervention is safe, effective and warranted in patients with a second lung primary cancer if they satisfy the usual criteria of operability after full assessment. This is true for patients with metachronous cancers, while patients with synchronous cancers tend to have worse prognosis. A long term follow-up policy after the initial resection of the primary lung cancer is recommended at intervals of 6 months for at least 3-5 years and then annually to enable the early detection of the second cancer.     

Lung cancer in patients with head and neck cancer. Incidence and long-term survival

Of the 3,907 cases of primary head and neck or lung cancer diagnosed between 1961 and 1984, 94 patients were identified with a history of cancer at both sites. The total incidence of lung cancer in our head and neck cancer patients was 5.4 percent. Of the 94 patients, 73 had both cancers diagnosed at our institution. These 73 patients were further analyzed. Squamous cell carcinoma accounted for 63 percent of the lung cancers. Twenty of the lung cancers were synchronous and 47 were metachronous after head and neck cancer. Of the synchronous lung cancers, 50 percent were postoperative stage I, whereas only 11 percent of the metachronous cancers were postoperative stage I. The lung cancer survival rate was significantly better for the synchronous cancer group at 5 years (34 percent) than for the metachronous cancer group (5 percent). The better survival rate was evidently due to the greater proportion of early-stage lung lesions. The relatively large number of advanced-stage lung lesions in the metachronous cancer group suggests that aggressive screening of head and neck cancer patients for lung cancer may detect more metachronous lung cancers at an earlier stage and thus improve the survival rate of these patients.     

胃癌合并其他器官原发癌103例分析

目的探讨胃癌合并其他器官恶性肿瘤的发生率、临床病理特征及其诊治和预后情况。方法对我院1983年1月至2010年12月期间治疗的103例胃癌合并其他器官原发癌患者的临床病理资料进行回顾性分析。结果本组103例患者占同期收治胃癌患者的2.26%(103/4 552)。确诊胃癌的年龄为(63.98±11.93)岁(30～84岁)。同时多原发癌29例;异时多原发癌74例,其中胃癌确诊前异时多原发癌46例,胃癌确诊后异时多原发癌28例。共发生胃癌以外恶性肿瘤113个,以结直肠癌最多,占27.43%(31/113),肺癌其次,占15.04%(17/113)。异时癌的发生时间距胃癌确诊前或后(87.95±92.98)个月(7～506个月),65.49%(74/113)合并的原发癌距胃癌确诊的间隔时间在5年内。全组患者总的5年累积生存率为48.43%,其中同时多原发癌患者为36.40%,胃癌确诊前发生多原发癌者为42.31%,胃癌确诊后发生多原发癌者为69.52%,胃癌确诊后发生者的预后明显好于胃癌确诊前发生者和同时发生者(P<0.023,P<0.009)。在死亡原因明确的33例患者中有20例因胃癌死亡。结论胃癌治疗时需注意同时并发其他器官原发癌的可能,对于这类患者胃癌仍然可能是影响其预后的主要原因。     

Bilateral cancer of the breast: a review of clinical, histologic, and immunohistologic characteristics.

The clinical, histologic, and immunohistologic characteristics of 19 synchronous and 47 metachronous bilateral breast cancers was compared. Patients with metachronous tumors were 5 years younger and more likely to have a family history of breast cancer than those patients with synchronous cancers. The nondominant synchronous cancer was usually discovered mammographically accounting for small, node-negative tumors, and high prevalence of in situ lesions. The same was true of the second metachronous tumor when discovered mammographically. Patients with metachronous cancers who were not in a follow-up program had second cancers with characteristics similar to incidentally diagnosed unilateral cancer. The mean interval between metachronous cancers was 101 months. Significantly more first metachronous tumors were invasive lobular cancers. Histologic type of the first and second tumor was the same in only 68% of synchronous and 61% of metachronous cancers. Combined histologic evidence and differentiation was concordant in only 13% and 22% of tumors, respectively. Immunoperoxidase studies were performed with two human milk fat globule antibodies. Each antibody reacted similarly in the first and second tumor in less than 50% of tumors and concordance was less than 25% when both antibody reactions were assessed. Differences in histologic evidence, differentiation, and immunohistologic reaction suggest that both synchronous and metachronous cancers are morphologically and functionally dissimilar.     

Squamous cell carcinoma of the head and neck and pulmonary cancer. Report of 50 cases

Association of a squamous cell carcinoma of the head and neck and a pulmonary cancer is frequent: prevalence is about 5 to 10 percent. The purpose of this study was to present the survival analysis of 50 patients, previously treated for a squamous cell carcinoma of the head and neck, and then treated for a pulmonary cancer between 1979 and 1996. Four patients were excluded from the analysis. Five pulmonary cancers were synchronous with the head and neck cancer, 41 were metachronous. Metachronous pulmonary cancer was asymptomatic in 87 percent and the mean interval between the two cancers was 53 months. Surgery was performed for every pulmonary cancer. Operative mortality was 11 percent. The overall 5-year survival rate was 25%. Survival rates were linked with the T and N stages of the pulmonary cancer: 46% for T1, 13% for T2 and 0% for T3 and T4, 67% for N0 ans 0% for N1-3. Indications for surgical treatment of synchronous and metachronous pulmonary cancers are discussed.     

Management of nonfamilial adenomatous polyps and colon cancers

There is evidence that patients with adenocarcinoma of the colon and synchronous adenomatous polyps are at an increased risk for developing metachronous colon cancer. A retrospective study was made of all patients with colon cancer at our institution and the associated Veterans Administration Hospital between 1974 and 1983 to help assess the need for more extensive colon resection in patients with colon cancer and synchronous adenomatous polyps. At our hospitals 470 new cases of colon cancer were identified. Nine percent (44/470) had colon cancer and concurrent adenomatous polyps. Seven (16%) of these 44 patients developed metachronous colon cancer, as compared with four of 426 patients without polyps at the initial surgery (p less than 0.001). Four patients without polyps at the initial surgery developed polyps at a later date; three of the four patients developed metachronous colon cancer. We believe that more extensive colon resection, such as total colectomy and ileoproctostomy, may play a role in preventing the occurrence of metachronous colon cancer in patients with colon cancer and synchronous adenomatous polyps. In addition, if adenomatous polyps develop after colon surgery, close endoscopic follow-up is required.     

Performing a colonoscopy 12 months after surgery for colorectal neoplasia

BACKGROUND: There appears to be acceptance that following up patients after surgery for colorectal neoplasia is of value. However, specific issues relating to which investigations to perform and how often remain unresolved. The aim of this project was to evaluate the clinical utility of performing a colonoscopy 12 months after curative surgery for colorectal neoplasia. METHODS: Patients were selected if they had undergone a curative resection for colorectal neoplasia, and if they had had a completed colonoscopy prior to surgery. Study endpoints included: (i) compliance with follow up; (ii) the prevalence, total number, size, and histology of polyps; and (iii) identification of recurrent or metachronous cancer. RESULTS: The study group included 253 patients of mean age 69.7 years (SD 11.6) and a male : female ratio of 1.4:1.0. Colonoscopies were completed on 90% of patients at a mean of 1.1 years following surgery. A total of 149 polyps were identified in 30% of patients. On histology, 42% were tubular adenomas, 6% tubulo-villous adenomas, 7% were villous adenomas, and 37% were hyperplastic. Advanced adenomas were identified in 7.9% of patients (95% CI 4.8-12.1%). No recurrent or metachronous cancers were identified. CONCLUSION: We have observed a high prevalence of advanced adenomas in patients undergoing a 12-month, follow-up colonoscopy after curative surgery for colorectal neoplasia. The significance of these observations requires further evaluation.