COLONOSCOPIC SURVEILLANCE AFTER CURATIVE RESECTION FOR COLORECTAL-CANCER

Colonoscopic surveillance after resection for colorectal cancer has be en advocated to improve detection of anastomotic recurrence, and of sy nchronous and metachronous tumours. The benefit provided by colonoscop y remains unproven, and the best timing of examination is unclear. To determine the value of colonoscopy after curative resection for large bowel cancer, the efficacy of an endoscopic surveillance programme in the early detection of intraluminal bowel recurrence in a series of pa tients admitted with colorectal cancer was examined. Between April 198 3 and December 1988, 132 patients underwent colonoscopy. Eight (6.1 pe r cent) were found to have intraluminal recurrence without evidence of extraluminal spread. Six of these recurrences were at the site of ana stomosis and two represented metachronous tumour development. All of t hese patients were symptomatic at the time of diagnosis. In 15 patient s (11.4 per cent), adenomatous polyps were discovered during the initi al endoscopic examination. These results indicate that colonoscopic su rveillance will rarely allow early detection of asymptomatic intralumi nal bowel recurrence, but is valuable in the detection of synchronous lesions. Frequent surveillance is not justified in the early postopera tive years and colonoscopy should probably be confined to a single pro cedure to exclude synchronous lesions.