Endoscopy 2019; 51(04): S208
DOI: 10.1055/s-0039-1681789
ESGE Days 2019 ePosters
Friday, April 5, 2019 09:00 – 17:00: Colon and rectum ePosters
Georg Thieme Verlag KG Stuttgart · New York

COLORECTAL CANCERS DETECTED FOLLOWING SURGERY AT ANASTOMOSES OR OTHER COLORECTAL LOCATIONS DURING COLONOSCOPY SURVEILLANCE: A SYSTEMATIC REVIEW AND META-ANALYSIS

L Fuccio
1   Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
,
D Rex
2   Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, United States
,
T Ponchon
3   Edouard Herriot University Hospital, Lyon, France
,
L Frazzoni
1   Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
,
M Dinis-Ribeiro
4   CIDES/CINTESIS, Faculty of Medicine, University of Porto, Porto, Portugal
,
P Bhandari
5   Queen Alexandra Hospital, Portsmouth, United Kingdom
,
E Dekker
6   Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
,
M Pellisé
7   Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
,
L Correale
1   Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
,
J van Hooft
6   Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
,
R Jover
8   Service of Digestive Medicine, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
,
D Libanio
4   CIDES/CINTESIS, Faculty of Medicine, University of Porto, Porto, Portugal
,
F Radaelli
9   Department of Gastroenterology, Valduce Hospital, Como, Italy
,
S Alfieri
10   Digestive Surgery Department, Catholic University, Rome, Italy
,
F Bazzoli
1   Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
,
C Senore
11   AOU Città della Salute e della Scienza, CPO Piemonte, Turin, Italy
,
J Regula
12   The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
,
T Seufferlein
13   Department of Internal Medicine I, University of Ulm, Ulm, Germany
,
T Rösch
14   Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
,
P Sharma
15   Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, United States
,
A Repici
16   Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research and University Hospital, Rozzano, Italy
,
C Hassan
17   Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

Aims:

Outcomes of endoscopic surveillance following surgery for colorectal cancer (CRC) vary with the incidence and timing of CRC detection, at anastomosis or elsewhere in the colorectum. We performed systematic review and meta-analysis to evaluate the incidence of CRCs identified during surveillance colonoscopies of patients with previous CRC surgery.

Methods:

We searched PubMed, EMBASE, SCOPUS, and the Cochrane Central Register through January 1, 2018 to identify studies investigating rates of CRCs at anastomoses or other colorectal locations after curative surgery for primary CRC. We collected data from randomized controlled, prospective, and retrospective cohort studies. Data were analyzed by multivariate meta-analytic models.

Results:

From 2,373 citations, we selected 27 studies with 15,803 index CRCs (89% stage I-III CRCs). Overall, 296 CRCs at non-anastomotic locations were reported over time periods of more than 16 years (cumulative incidence, 2.2% of CRCs; 95% CI, 1.8%-2.9%).

The risk of non-anastomotic CRC significantly decreased after 36 months or more from resection, compared with that before this timepoint (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 from surgery.

One hundred fifty-eight anastomotic CRCs were detected over more than 16-years follow-up (cumulative incidence of 2.7%; 95% CI, 1.9%-3.9%). The risk of anastomotic CRCs was significantly lower after 24 months or more from 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 anastomotic CRCs were detected within 36 months from surgery.

Conclusions:

After surgery for CRC, the highest risk of anastomotic and non-anastomotic CRCs 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.