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Gastrointest Endosc. 2015 Aug;82(2):325-333.e2. doi: 10.1016/j.gie.2014.12.052. Epub 2015 Apr 2.

Metachronous colorectal cancers result from missed lesions and non-compliance with surveillance.

Author information

1
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands; GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
2
Department of Methodology and Statistics, Maastricht University Medical Center, Maastricht, The Netherlands; CAPHRI, School for Public Health and Primary Care, Maastricht University Medical Center, Maastricht, The Netherlands.
3
Department of Internal Medicine and Gastroenterology, Atrium Medical Center Heerlen, Heerlen, The Netherlands.
4
Department of Internal Medicine and Gastroenterology, Orbis Medical Center Sittard, Sittard, The Netherlands.
5
GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
6
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands; NUTRIM, School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands.

Abstract

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.

PMID:
25843613
DOI:
10.1016/j.gie.2014.12.052
[Indexed for MEDLINE]

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