Preoperative endoscopy localization error rate in patients with colorectal cancer

Saleh, Fady; Abbasi, Thamer Al; Cleghorn, Michelle C.; Jimenez, M. Carolina; Jackson, Timothy; Okrainec, Allan; Quereshy, Fayez A.

doi:10.1007/s00464-014-3969-9

Cited by 22 publications

(20 citation statements)

References 19 publications

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“…Our finding that 56% of general surgeons agree that repeat colonoscopy often leads to change in surgical management underlines the importance of accurate localization and reporting of this information among endoscopists. This finding is supported by a recent study by Saleh and colleagues, 22 who demonstrated that repeat endoscopy was protective against localization error, with a sensitivity greater than 80% in detecting errors. These conflicting perceptions are likely secondary to the lack of standardized protocols that guide endoscopists with respect to the indications for repeat endoscopy and the indications for tattooing.…”

Section: Repeat Colonoscopy Prior To Crc Surgerysupporting

confidence: 74%

Discrepancy between gastroenterologists’ and general surgeons’ perspectives on repeat endoscopy in colorectal cancer

Azin

Jimenez

Cleghorn

et al. 2016

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Background: A myriad of localization options are available to endoscopists for colorectal cancer (CRC); however, little is known about the use of such techniques and their relation to repeat endoscopy before CRC surgery. We examined the localization practices of gastroenterologists and compared their perceptions toward repeat endoscopy to those of general surgeons. Methods:We distributed a survey to practising gastroenterologists through a provincial repository. Univariate analysis was performed using the χ 2 test.Results: Gastroenterologists (n = 69) reported using anatomical landmarks (91.3%), tattooing (82.6%) and image capture (73.9%) for tumour localization. The majority said they would tattoo lesions that could not be removed by colonoscopy (91.3%), high-risk polyps (95.7%) and large lesions (84.1%). They were equally likely to tattoo lesions planned for laparoscopic (91.3%) or open (88.4%) resection. Rectal lesions were less likely to be tattooed (20.3%) than left-sided (89.9%) or right-sided (85.5%) lesions. Only 1.4% agreed that repeat endoscopy is the standard of care, whereas 38.9% (n = 68) of general surgeons agreed (p < 0.001). General surgeons were more likely to agree that an incomplete initial colonoscopy was an indication for repeat endoscopy (p = 0.040). Further, 56% of general surgeons indicated that the findings of repeat endoscopy often lead to changes in the operative plan. Conclusion:Discrepancies exist between gastroenterologists and general surgeons with regards to perceptions toward repeat endoscopy and its indications. This is especially significant given that repeat endoscopy often leads to change in surgical management. Further research is needed to formulate practice recommendations that guide the use of repeat endoscopy, tattoo localization and quality reporting. Contexte :De nombreuses options de repérage s'offrent aux endoscopistes dans les cas de cancer colorectal; on en sait cependant peu sur l'utilisation de ces techniques et leur lien avec les endoscopies répétées avant les interventions chirurgicales de traitement de ce cancer. Nous avons étudié les pratiques de repérage employées par des gastroentérologues et comparé leurs perceptions des endoscopies répétées à celles des chirurgiens généralistes.Méthodes : Nous avons réalisé un sondage auprès de gastroentérologues en exercice figurant dans un répertoire provincial. Une analyse unidimensionnelle a été effectuée à l'aide du test χ².

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Section: Repeat Colonoscopy Prior To Crc Surgerysupporting

confidence: 74%

Discrepancy between gastroenterologists’ and general surgeons’ perspectives on repeat endoscopy in colorectal cancer

Azin

Jimenez

Cleghorn

et al. 2016

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“…Recently, the European Society for Medical Oncology (ESMO) published revised guidelines on rectal cancer and now uses 0-15 cm as the rectal cancer border and rigid endoscopy as the preferred method to define tumor location [3]. However, endoscopy has a considerable error rate of 6.4% regarding tumor localization [12]. This could result in an alteration of preoperative treatment or a change to another surgical procedure in 11% to 21% of the cases [13][14][15].…”

Section: Discussionmentioning

confidence: 99%

Determination of Tumor Location in Rectosigmoid Carcinomas: Difficulties in Preoperative Diagnostics

Moltzer

Noordman

Renken

et al. 2019

Gastrointestinal Disorders

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Differentiation between rectal and sigmoid carcinomas is a diagnostic challenge with important implications for further treatment. Depending on the tumor stage, treatment for rectal carcinoma consists of preoperative (chemo)radiotherapy and surgery. Sigmoid carcinomas are treated with surgery alone. We established the diagnostic accuracy of flexible endoscopy, MRI and/or CT scan, and both modalities combined as reflected by the conclusion of our multidisciplinary team (MDT). Furthermore, we assessed the treatment consequences of misdiagnosis. Consecutive patients were included who underwent surgery from January 2012 to January 2017 for colorectal carcinoma located ≤20 cm from the anal verge as determined by flexible colonoscopy. Diagnostic accuracy of MRI/CT, flexible endoscopy and the final MDT conclusion were analyzed as index test. The location of the tumor during surgery and the type of surgery was the reference standard. We included 293 patients. Flexible endoscopy had a diagnostic accuracy of 90% and for MRI/CT scanning this was 86–87%. Combination of both modalities improved diagnostic accuracy to 96%. Due to misdiagnosis during initial staging, three patients (1%) erroneously underwent neoadjuvant treatment and in two patients neoadjuvant treatment was potentially erroneously omitted. In conclusion, the combination of both flexible endoscopy and MRI/CT (the MDT conclusion) improves diagnostic accuracy. Erroneous clinical diagnosis can lead to under- and overtreatment.

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“…There have been several studies supporting the finding that colonoscopy alone is inaccurate to identify the location of the colon mass and should not be used alone for surgical planning, especially if one is planning a laparoscopic approach, where the surgeon cannot feel the colon to identify the mass 8 9 10 . Colonoscopy incorrectly localized the tumor in these studies between 6 % and 21 %.…”

Section: Discussionmentioning

confidence: 99%

Location of colorectal cancer: colonoscopy versus surgery. Yield of colonoscopy in predicting actual location

Blum-Guzman

Melo

2017

Endosc Int Open

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Background and study aims Recent studies suggest that differences in biological characteristics and risk factors across cancer site within the colon and rectum may translate to differences in survival. It can be challenging at times to determine the precise anatomical location of a lesion with a luminal view during colonoscopy. The aim of this study is to determine if there is a significant difference between the location of colorectal cancers described by gastroenterologists in colonoscopies and the actual anatomical location noted on operative and pathology reports after colon surgery. Patients and methods A single-center retrospective analysis of colonoscopies of patient with reported colonic masses from January 2005 to April 2014 (n = 380) was carried. Assessed data included demography, operative and pathology reports. Findings were compared: between the location of colorectal cancers described by gastroenterologists in colonoscopies and the actual anatomical location noted on operative reports or pathology samples. Results We identified 380 colonic masses, 158 were confirmed adenocarcinomas. Of these 123 underwent surgical resection, 27 had to be excluded since no specific location was reported on their operative or pathology report. An absolute difference between endoscopic and surgical location was found in 32 cases (33 %). Of these, 22 (23 %) differed by 1 colonic segment, 8 (8 %) differed by 2 colonic segments and 2 (2 %) differed by 3 colonic segments. Conclusion There is a significant difference between the location of colorectal cancers reported by gastroenterologists during endoscopy and the actual anatomical location noted on operative or pathology reports after colon surgery. Endoscopic tattooing should be used when faced with any luminal lesions of interest.

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Preoperative endoscopy localization error rate in patients with colorectal cancer

Cited by 22 publications

References 19 publications

Discrepancy between gastroenterologists’ and general surgeons’ perspectives on repeat endoscopy in colorectal cancer

Discrepancy between gastroenterologists’ and general surgeons’ perspectives on repeat endoscopy in colorectal cancer

Determination of Tumor Location in Rectosigmoid Carcinomas: Difficulties in Preoperative Diagnostics

Location of colorectal cancer: colonoscopy versus surgery. Yield of colonoscopy in predicting actual location

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