Background
Several studies examined the rate of colorectal cancer (CRC) developed during colonoscopy
surveillance after CRC resection (ie, metachronous CRC [mCRC]), yet the underlying
etiology is unclear.
Objective
To examine the rate and likely etiology of mCRCs.
Design
Population-based, multicenter study. Review of clinical and histopathologic records,
including data of the national pathology database and The Netherlands Cancer Registry.
Setting
National cancer databases reviewed at 3 hospitals in South-Limburg, The Netherlands.
Patients
Total CRC population diagnosed in South-Limburg from January 2001 to December 2010.
Interventions
Colonoscopy.
Main Outcome Measurements
We defined an mCRC as a second primary CRC, diagnosed >6 months after the primary
CRC. By using a modified algorithm to ascribe likely etiology, we classified the mCRCs
into cancers caused by non-compliance with surveillance recommendations, inadequate
examination, incomplete resection of precursor lesions (CRC in same segment as previous
advanced adenoma), missed lesions, or newly developed cancers.
Results
We included a total of 5157 patients with CRC, of whom 93 (1.8%) had mCRCs, which
were diagnosed on an average of 81 months (range 7-356 months) after the initial CRC
diagnosis. Of all mCRCs, 43.0% were attributable to non-compliance with surveillance
advice, 43.0% to missed lesions, 5.4% to incompletely resected lesions, 5.4% to newly
developed cancers, and 3.2% to inadequate examination. Age-adjusted and sex-adjusted
logistic regression analyses showed that mCRCs were significantly smaller in size
(odds ratio [OR] 0.8; 95% confidence interval [CI], 0.7-0.9) and more often poorly
differentiated (OR 1.7; 95% CI, 1.0-2.8) than were solitary CRCs.
Limitations
Retrospective evaluation of clinical data.
Conclusion
In this study, 1.8% of all patients with CRC developed mCRCs, and the vast majority
were attributable to missed lesions or non-compliance with surveillance advice. Our
findings underscore the importance of high-quality colonoscopy to maximize the benefit
of post-CRC surveillance.
Abbreviations:
CRC (colorectal cancer), mCRC (metachronous CRC), PALGA (national pathology database), TNM (tumor, node, metastasis)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 02, 2015
Accepted:
December 21,
2014
Received:
October 7,
2014
Footnotes
DISCLOSURE: C.M.C. le Clercq was the recipient of an unrestricted educational grant from Pentax B.V., The Netherlands. Pentax had no role in the design of the study, data collection, analysis and interpretation, writing of the manuscript, or decision to submit for publication. All other authors disclosed no financial relationships relevant to this article.
Identification
Copyright
© 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
