Ap. Barlow et Mh. Thompson, COLONOSCOPIC FOLLOW-UP AFTER RESECTION FOR COLORECTAL-CANCER - A SELECTIVE POLICY, British Journal of Surgery, 80(6), 1993, pp. 781-784
A policy of selective colonoscopy after resection for colorectal cance
r was evaluated to assess the benefit of detecting missed synchronous
and metachronous tumours in patients under 70 years of age with a good
prognosis, and the possible risk of missing such lesions in those not
screened. With preoperative barium enema and palpation at laparotomy,
synchronous cancers and adenomas were found in 2 and 28 per cent, res
pectively, of 275 consecutive patients undergoing resection. Eighty-fi
ve patients were selected for postoperative colonoscopy, which was rep
eated at least once in 32, there being a total of 60 repeat examinatio
ns. Adenomas, but no cancers, were found in 19 patients (22 per cent)
on first screening, but on repeat colonoscopy early metachronous cance
rs were detected in three patients (9 per cent) and adenomas on 21 exa
minations (35 per cent). Only one of the patients followed by clinical
examination developed a symptomatic tumour. This suggests that postop
erative colonoscopy is unlikely to benefit the majority but may be ext
remely important for young fit patients with continuing polyp formatio
n who are at high risk of developing metachronous cancer.