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

L Fuccio; D Rex; T Ponchon; L Frazzoni; M Dinis-Ribeiro; P Bhandari; E Dekker; M Pellisé; L Correale; J van Hooft; R Jover; D Libanio; F Radaelli; S Alfieri; F Bazzoli; C Senore; J Regula; T Seufferlein; T Rösch; P Sharma; A Repici; C Hassan

doi:10.1055/s-0039-1681789

Endoscopy, Table of Contents

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

¹Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy

,

D Rex

²Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, United States

,

T Ponchon

³Edouard Herriot University Hospital, Lyon, France

,

L Frazzoni

¹Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy

,

M Dinis-Ribeiro

⁴CIDES/CINTESIS, Faculty of Medicine, University of Porto, Porto, Portugal

,

P Bhandari

⁵Queen Alexandra Hospital, Portsmouth, United Kingdom

,

E Dekker

⁶Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands

,

M Pellisé

⁷Gastroenterology 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

¹Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy

,

J van Hooft

⁶Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands

,

R Jover

⁸Service of Digestive Medicine, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain

,

D Libanio

⁴CIDES/CINTESIS, Faculty of Medicine, University of Porto, Porto, Portugal

,

F Radaelli

⁹Department of Gastroenterology, Valduce Hospital, Como, Italy

,

S Alfieri

¹⁰Digestive Surgery Department, Catholic University, Rome, Italy

,

F Bazzoli

¹Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy

,

C Senore

¹¹AOU Città della Salute e della Scienza, CPO Piemonte, Turin, Italy

,

J Regula

¹²The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland

,

T Seufferlein

¹³Department of Internal Medicine I, University of Ulm, Ulm, Germany

,

T Rösch

¹⁴Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany

,

P Sharma

¹⁵Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, United States

,

A Repici

¹⁶Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research and University Hospital, Rozzano, Italy

,

C Hassan

¹⁷Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy

› Author Affiliations

Abstract

Full Text

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.