Task Force issues guidance on colonoscopy surveillance after CRC resection

Last Updated: 2016-02-18

By Megan Brooks

NEW YORK (Reuters Health) - The U.S. Multi-Society Task Force on Colorectal Cancer (CRC) has released updated recommendations on colonoscopy surveillance after colorectal cancer (CRC) resection with curative intent.

In 2006, the Task Force published a consensus guideline to address the use of endoscopy for patients after CRC resection. Their updated document focuses on the role of colonoscopy after CRC resection.

"Because of the long interval since the last iteration we considered it time to update the recommendations," Task Force member Dr Douglas Rex from Indiana University in Indianapolis told Reuters Health by email.

The recommendations say patients with CRC should undergo high-quality perioperative clearing with colonoscopy. The procedure should be performed before surgery, or within three to six months after surgery in the case of obstructive CRC. The goals of perioperative clearing colonoscopy are detection of synchronous cancer and detection and complete resection of precancerous polyps.

The Task Force also recommends that patients who have had curative resection of either colon or rectal cancer undergo an initial surveillance colonoscopy one year after surgery (or one year after the clearing perioperative colonoscopy).

After the one-year colonoscopy, the interval to the next colonoscopy should be three years (ie, four years after surgery or perioperative colonoscopy) and then five years (ie, nine years after surgery or perioperative colonoscopy), the Task Force says.

Subsequent colonoscopies should be performed at five-year intervals until the benefit of continued surveillance is outweighed by diminishing life expectancy. If neoplastic polyps are detected, the intervals between colonoscopies should be in accordance with published guidelines for polyp surveillance intervals. These intervals do not apply to patients with Lynch syndrome.

According to the Task Force, "Evidence shows that although postoperative colonoscopy is associated with improved overall survival, there is no effect on cancer-specific death, and no survival benefit associated with frequent performance of surveillance colonoscopy."

The Task Force also notes that patients with localized rectal cancer who have had surgery without total mesorectal excision, those who have had transanal local excision or endoscopic submucosal dissection, and those with locally advanced rectal cancer who did not have neoadjuvant chemoradiation and then surgery using total mesorectal excision techniques, are at increased risk for local recurrence.

In these situations, the recommendations suggest local surveillance with flexible sigmoidoscopy or endoscopic ultrasound (EUS) every three to six months for the first two to three years after surgery. These surveillance measures are in addition to recommended colonoscopic surveillance for metachronous neoplasia.

For patients with obstructive CRC precluding complete colonoscopy, the Task Force says computed tomography colonography (CTC) is the best alternative to exclude synchronous neoplasms. Double-contrast barium enema is an acceptable alternative if CTC is not available.

They note that there is currently not enough evidence to recommend the routine use of fecal immunochemical tests (FIT) or fecal DNA for surveillance after CRC resection.

The U.S. Multi-Society Task Force on CRC includes gastroenterology experts with specific interest in CRC from the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy.

The draft recommendations were circulated to members of the Task Force, and final recommendations were developed by consensus. The document underwent committee review and was approved by the governing boards of all three societies.

The recommendations were published online February 10 in Gastroenterology. They are also being published in the American Journal of Gastroenterology, and Gastrointestinal Endoscopy.

SOURCE: http://bit.ly/1KYbQVO

Gastroenterol 2016.