Routine endoscopic surveillance for local recurrence of rectal cancer is futile

Martin, Luke; Gross, Molly E.; Mone, Mary C.; Whiting, Christopher K.; Hansen, Heidi; Mecham, Elise; Peche, William; Scaife, Courtney L.

doi:10.1016/j.amjsurg.2015.06.027

Cited by 6 publications

(7 citation statements)

References 32 publications

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“…Our findings suggest that rectoscopy is poor at detecting local recurrence. These findings are in agreement with the only other study on the subject, in which rectoscopy failed to diagnose the one local recurrence in 112 patients [5].…”

Section: Discussionsupporting

confidence: 93%

“…According to the Norwegian national guidelines, follow‐up after low anterior rectal resection is conducted by the surgeon and comprises rigid rectoscopy every 6 months for the first 3 years and every 12 months for the following 2 years (Table ) . Rectoscopy is considered a relatively easy and cheap examination, although patients may experience pain, discomfort and anxiety . However, the effectiveness of rectoscopy in detecting local recurrence after surgery for rectal malignancy has not been studied.…”

Section: Introductionmentioning

confidence: 99%

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Low rate of local recurrence detection by rectoscopy in follow‐up of rectal cancer

et al. 2019

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Aim The main aim of this study was to examine the effectiveness of rectoscopy for detecting local recurrence of rectal cancer in patients following low anterior resection. Method This was a retrospective study of 201 patients, who underwent low anterior resection for rectal or rectosigmoid cancer between 2007 and 2009 and who were followed up with rigid rectoscopy and imaging. A total of 91 patients were excluded from the analysis for various reasons, leaving 110 patients eligible for analysis. Results A total of 613 rectoscopies were performed, and 48 biopsies taken. Six local recurrences were detected in the 110 patients, three of which were first detected by rectoscopy and three by CT. Two of the local recurrences were detected outside the follow‐up programme because of symptoms: one by rectoscopy and one by CT. Three of 613 (0.5%) rectoscopies led to detection of local recurrence. The sensitivity and specificity of rectoscopy to detect local recurrence was 0.50 and 0.93, respectively. Nineteen distant metastases were detected, and two patients had both local recurrence and distant metastasis. All local recurrences and distant metastases were detected within 48 months of surgery. Conclusion Rigid rectoscopy is poor at detecting local recurrence. Only 3 out of 613 rectoscopies (0.5%) detected local recurrence. Due to extramural growth of some recurrences, the sensitivity is also very low. Based on our results, routine rectoscopy in the surveillance of asymptomatic patients cannot be recommended.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Low rate of local recurrence detection by rectoscopy in follow‐up of rectal cancer

et al. 2019

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“…Highest level of evidence referred to in the guidelines: ≥3b . It concludes that endoscopic surveillance of the rectum is not effective in identifying local recurrences of rectal cancer.…”

Section: Resultsmentioning

confidence: 99%

“…The guidelines included in this synopsis did not result in consensus for recommending routine rectoscopy, even though six guidelines did recommend it. A recent retrospective study revealed no effect from frequent rectoscopy on the detection of local recurrences from resected rectal cancer .…”

Section: Discussionmentioning

confidence: 98%

Consensus and controversies regarding follow‐up after treatment with curative intent of nonmetastatic colorectal cancer: a synopsis of guidelines used in countries represented in the European Society of Coloproctology

et al. 2019

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Aim It is common clinical practice to follow patients for a period of years after treatment with curative intent of nonmetastatic colorectal cancer, but follow‐up strategies vary widely. The aim of this systematic review was to provide an overview of recommendations on this topic in guidelines from member countries of the European Society of Coloproctology, with supporting evidence. Method A systematic search of Medline, Embase and the guideline databases Trip database, BMJ Best Practice and Guidelines International Network was performed. Quality assessment included use of the AGREE‐II tool. All topics with recommendations from included guidelines were identified and categorized. For each subtopic, a conclusion was made followed by the degree of consensus and the highest level of evidence. Results Twenty‐one guidelines were included. The majority recommended that structured follow‐up should be offered, except for patients in whom treatment of recurrence would be inappropriate. It was generally agreed that clinical visits, measurement of carcinoembryoinc antigen and liver imaging should be part of follow‐up, based on a high level of evidence, although the frequency is controversial. There was also consensus on imaging of the chest and pelvis in rectal cancer, as well as endoscopy, based on lower levels of evidence and with a level of intensity that was contradictory. Conclusion In available guidelines, multimodal follow‐up after treatment with curative intent of colorectal cancer is widely recommended, but the exact content and intensity are highly controversial. International agreement on the optimal follow‐up schedule is unlikely to be achieved on current evidence, and further research should refocus on individualized ‘patient‐driven’ follow‐up and new biomarkers.

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“…Colonoscopy at 1 year after surgery with repeat intervals based on status of adenoma and based on expert opinion is recommended for them as well as those with stage I nonLynch rectal cancer. 123 Stage II and III patients are recommended for intensive postoperative surveillance due to a risk of 5 to 30% recurrence rate. A recent study reported that 95% of CRC recurrences occur within 5 years post-treatment, 124 while data from 20,898 patients in 18 colon cancer trials found that 80% of recurrences occur within the first 3 years.…”

Section: Surveillancementioning

confidence: 99%

Localized Rectal Cancer: Indian Consensus and Guidelines

Lavingia,

Sardana,

Khanderia

et al. 2024

Indian J Med Paediatr Oncol

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The rising incidence of colorectal cancer (CRC) in India, particularly the prevalence of rectal cancer over colon cancer (0.7:1), has been a growing concern in recent decades; especially notable is the trend of increasing cases among young CRC patients. Given the diverse treatment approaches for rectal cancer globally and the varying economic capacities of patients in low to middle-income countries (LMICs) like India, it is essential to establish consensus guidelines that are specifically tailored to meet the needs of these patients. To achieve this, a panel comprising 30 eminent rectal cancer experts convened to conduct a comprehensive and impartial evaluation of existing practices and recent advancements in the field. Through meticulous scrutiny of published literature and a consensus-building process that involved voting on pertinent questions, the panel formulated management strategies. These recommendations are the result of a rigorous, evidence-based process and encapsulate the collective wisdom and judgment of leading authorities in the field.

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Routine endoscopic surveillance for local recurrence of rectal cancer is futile

Cited by 6 publications

References 32 publications

Low rate of local recurrence detection by rectoscopy in follow‐up of rectal cancer

Low rate of local recurrence detection by rectoscopy in follow‐up of rectal cancer

Consensus and controversies regarding follow‐up after treatment with curative intent of nonmetastatic colorectal cancer: a synopsis of guidelines used in countries represented in the European Society of Coloproctology

Localized Rectal Cancer: Indian Consensus and Guidelines

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