Pre-operative or postoperative colonic examination for synchronous lesions in colorectal cancer

Abstract

A review of 130 consecutive large bowel examinations at which a cancer of the colon or rectum was diagnosed has been undertaken. Of 50 patients examined by colonoscopy, the whole colon was seen in only 21 (42 per cent) and almost half of these had a tumour in the caecum or ascending colon. In most cases, an incomplete examination was the result of narrowing of the lumen by the tumour preventing passage of the endoscope. Of 80 patients examined by double contrast barium enema, the entire length of the colon was visualized in 83 per cent but the quality of the examination was sufficient to confidently exclude synchronous neoplastic lesions in only 51 per cent. The incidence of synchronous cancer in this series was within the expected range, although two such cancers were not detected until laparotomy, but the incidence of synchronous adenomas was two-thirds of the expected number in colonoscopy patients and one-third in those examined by barium enema. It is concluded that, in patients with known colorectal cancer, preoperative investigation is unreliable for the detection of all synchronous neoplasia and that patients should have postoperative colonoscopy.

Detection and treatment of synchronous lesions in colorectal cancer: The clinical implication of perioperative colonoscopy

“…It has been reported that a preoperative colonoscopy was not possible in as many as 50% of cases although our study shows a lower rate [13,14] . Tumor stenosis of the Table 3 Treatment of synchronous lesions 1 Dual procedure were performed for some patients, therefore, the sum exceeds the total number of patients.…”

Synchronous multiple colorectal adenocarcinomas

“…It is therefore essential to ascertain preoperatively whether a second lesion exists. Although other workers have reported that the rate of a successful total colonoscopy from anus to cecum was 75% on the average [15], colonoscopy is currently regarded as the most accurate method for the diagnosis of colorectal carcinoma [12,16]. The predominance of colonoscopy over DCBE has also been recognized [6].…”

“…DCBE is still not completely reliable with regard to detection of all lesions. Tate et al [12] reported that one reason the quality of DCBE is unsatisfactory in the case of synchronous colorectal carcinomas is the inhibition of effective bowel preparation by coexisting tumors. It could be stated that a good surgeon could detect malignant lesions by palpation at laparotomy, but Hancock [1] has shown that such intraoperative palpation is not always a sensitive method, especially when the tumor is at an earlier histological stage.…”

“…Intraoperative endoscopy is one available method to perform a complete examination of the colon and rectum. However, it is time-consuming and makes closure of the abdomen difficult since the bowel becomes distended with air [12].…”

“…Kune et al [11] reported that colorectal polyps may have a sixfold increased risk of a colorectal carcinoma developing, and their presence is thought to be associated with an increased risk for metachronous colorectal carcinomas [8,12].…”