Preoperative re-endoscopy in colorectal cancer patients: an institutional experience and analysis of influencing factors

Abstract

The repeat preoperative endoscopy rate in CRC patients was 40.5%. Re-endoscopy was associated with an initial failure to tattoo the lesion, left-sided colonic neoplasms, and a planned laparoscopic resection. Further research is needed to help identify which patients would benefit from re-endoscopy and where this may be safely omitted.

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

“…Interestingly, our study demonstrates that gastroenterologists are likely to tattoo malignancies in the right colon despite evidence that right-sided lesions close to known anatomical landmarks, such as the ileocecal junction or appendiceal orifice, may not require tattoo localization. 19 The finding that gastroenterologists are likely to tattoo left-sided lesions and lesions that will be referred for laparoscopic surgery (91.3%) builds on recent work by Al Abbasi and colleagues, 11 who showed a significant increase in the rate of repeat endoscopy before CRC surgery for leftsided lesions and planned laparoscopic surgery.…”

“…Factors associated with preoperative repeat endoscopy by the operating surgeon were left-sided colonic neoplasms, planned laparoscopic resection and failure to tattoo the lesion on the initial colonoscopy. 11 However, to our knowledge, no studies have assessed the perceptions of gastroenterologists toward repeat endoscopy and its indications.…”

“…Tattoo localization is considered the most accurate localization technique, and lack of tattoo localization is the most cited reason for repeat endoscopy by the operating surgeon. 11,14 Nevertheless, the rate of tattooing remains quite low -between 0% and 23%. 15,16 Furthermore, while tattoo localization is often recommended for colonic lesions suspicious for malignancy, 17 the use of tattooing in different clinical scen arios remains unclear.…”

Preoperative repeat endoscopy for colorectal cancer: What is its role and when is it necessary?

“…For instance, a reported 40.5% of patients undergoing colorectal cancer surgery at a multi-institution tertiary care centre underwent preoperative repeat endoscopy between 2008 and 2011. 1 The most common indications cited were tattooing of the lesion, optimal surgical planning and repeated therapeutic attempt. 1 This practice has, in part, resulted from a shift in surgical management, with increasing reliance on minimally invasive techniques, but also from a lack of standardized guidelines on appropriate tumour localization, including tattooing, and optimal colonoscopic reporting among clinicians.…”

“…1 The most common indications cited were tattooing of the lesion, optimal surgical planning and repeated therapeutic attempt. 1 This practice has, in part, resulted from a shift in surgical management, with increasing reliance on minimally invasive techniques, but also from a lack of standardized guidelines on appropriate tumour localization, including tattooing, and optimal colonoscopic reporting among clinicians. 2,3 However, despite its increasing use and potential role in correcting localization errors, the procedure itself carries inherent risk, may lead to patient discomfort, and is associated with a delay to definitive treatment.…”