Silvia Sanduleanu, MD, PhD, from the Division of Gastroenterology and Hepatology, Department of Internal Medicine, GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, in Maastricht, The Netherlands discusses this Original Article, “Metachronous colorectal cancers result from missed lesions and non-compliance with surveillance.”
Worldwide, the incidence of colorectal cancer (CRC) still increases with aging of the population and implementation of CRC screening programs. The number of patients under surveillance after colonic surgery for CRC will therefore increase in the future. Up to 4% of these patients develop a second primary (i.e. metachronous) CRC during surveillance. With this in mind, it is necessary to clarify what factors may influence the success of post-CRC surveillance strategies. The aim of our study was to clarify the factors associated with development of metachronous CRCs with special attention to the quality of colonoscopic examination. A clear understanding of such factors may help to optimize the effectiveness of post-CRC surveillance.
In this retrospective population-based study, 1.8% of the patients with a diagnosis of CRC developed a metachronous CRC during a mean follow-up duration of 6 years. Based on clinical judgment (i.e. the time elapsed from prior colonoscopy to CRC diagnosis, the stage of the tumor at diagnosis, and findings at last colonoscopy), each metachronous CRC was ascribed to one of the following potential explanations: non-compliance with surveillance intervals, inadequate bowel examination, incomplete polyp resection, missed lesions, or newly developed cancers. We found that the vast majority of metachronous CRCs were attributable to missed lesions (43%) or non-compliance with surveillance advice (43%), suggesting that not only the frequency, but also the quality of colonoscopic surveillance is important to prevent CRC. Of note, metachronous CRCs were often small in size and had a non-protruding shape, indicating that such cancers or their precursors could be missed at previous colonoscopy. Our findings increase clinical awareness about the importance of strict adherence to surveillance guidelines and high-quality colonoscopy to maximize the benefit of post-CRC surveillance.
Find the abstract for this article here.
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