Benefits of colonoscopic surveillance after curative resection of colorectal cancer.

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OBJECTIVE: The authors determined the usefulness of routine colonoscopy after colorectal cancer surgery. SUMMARY BACKGROUND DATA: Some studies suggest benefit to colonoscopy in the routine follow-up of patients with colorectal cancer who are resected for cure, whereas other studies show no benefit. METHODS: Chart review was conducted for 290 patients who underwent curative resection for colorectal cancer between 1967 and 1991 at a colorectal surgeon's practice. Colonoscopy was performed every 6 months during the first year, then every 1 to 2 years, or when intercurrent symptoms appeared. RESULTS: Overall, 31 patients (10.7%) developed recurrent disease, which increased as a function of stage (C2 > B2 > A), with a median time to diagnosis of 20 months. Of these 31 recurrences, 14 (45.2%) were solely local (of whom 12 were asymptomatic); 17 (54.8%) involved distant disease. Nine locally recurrent patients were able to undergo curative resection. Of 19 symptomatic patients, only 3 (15.8%) were amenable to curative resection. Six patients (2.1%) developed a metachronous second primary colorectal cancer, of whom four (66.7%) were asymptomatic, and five (83.3%) were able to undergo curative resection. Overall, because of surveillance colonoscopies, 13 asymptomatic patients (4.5%) had curative resection for localized recurrent disease or a metachronous second primary cancer. CONCLUSIONS: Colonoscopy is a useful modality in the early detection of recurrent and metachronous disease after colorectal cancer, increasing the potential for curative resection and improved survival.

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