Charles J. Kahi1,2, C. Richard Boland3, Jason A. Dominitz4,5, Francis M. Giardiello6, David A. Johnson7, Tonya Kaltenbach8,9, David Lieberman10, Theodore R. Levin11, Douglas J. Robertson12,13; Douglas K. Rex2
1Richard L. Roudebush VA Medical Center, Indianapolis, IN; 2Indiana University School of Medicine, Indianapolis, Indiana; 3Baylor University Medical Center at Dallas, Dallas, Texas; 4VA Puget Sound Health Care System, Seattle, Washington; 5University of Washington School of Medicine, Seattle, Washington; 6Johns Hopkins University School of Medicine, Baltimore, Maryland; 7Eastern VA Medical School, Norfolk, Virginia; 8Veterans Affairs Palo Alto, Palo Alto, California; 9Stanford University School of Medicine, Palo Alto, California; 10Oregon Health and Science University, Portland, Oregon; 11Kaiser Permanente Medical Center, Walnut Creek, California; 12VA Medical Center, White River Junction, Vermont; 13Geisel School of Medicine at Dartmouth, Hanover, NH.
Am J Gastroenterol advance online publication, 12 February 2016; doi: 10.1038/ajg.2016.22
Received 23 November 2015; accepted 7 December 2015
SUPPLEMENTARY MATERIAL is linked to the online version of the paper at http://www.nature.com/ajg
Correspondence: Tram T. Tran, MD, FACG, FAASLD, Department of Medicine, Liver Transplant, Cedars Sinai Medical Center, Los Angeles, California 90048, USA. E-mail: TranT@cshs.org
The US Multi-Society Task Force has developed updated recommendations to guide health care providers with the surveillance of patients after colorectal cancer (CRC) resection with curative intent. This document is based on a critical review of the literature regarding the role of colonoscopy, flexible sigmoidoscopy, endoscopic ultrasound, fecal testing and CT colonography in this setting. The document addresses the effect of surveillance, with focus on colonoscopy, on patient survival after CRC resection, the appropriate use and timing of colonoscopy for perioperative clearing and for postoperative prevention of metachronous CRC, specific considerations for the detection of local recurrence in the case of rectal cancer, as well as the place of CT colonography and fecal tests in post-CRC surveillance.
In the United States, colorectal cancer (CRC) is the second leading cause of cancer deaths for men and women combined (1). Of the estimated 132,700 new cases expected to be diagnosed in 2015 (1), 70–80% will undergo surgical resection with curative intent (2, 3) and up to 40% of patients with locoregional disease will develop recurrent cancer, of which 90% will occur within 5 years (4). The postoperative surveillance of patients treated for CRC is intended to prolong survival by diagnosing recurrent and metachronous cancers at a curable stage, and to prevent metachronous cancer by detection and removal of precancerous polyps.
Surveillance strategies employ a combination of modalities, including history and physical examination, carcinoembryonic antigen (CEA), computed tomography (CT) scans, and endoluminal imaging, including colonoscopy, sigmoidoscopy, endoscopic ultrasound (EUS), and CT colonography (CTC). Although the optimal surveillance strategy is still not clearly defined, the role of colonoscopy is primarily to clear the colon of synchronous cancers and polyps and prevent metachronous neoplasms.
In 2006, the US Multi-Society Task Force (USMSTF) published a consensus guideline to address the use of endoscopy for patients after CRC resection (5). This updated document focuses on the role of colonoscopy in patients after CRC resection. Additionally, based on a comprehensive literature review updated from the 2006 recommendations, we review the possible adjunctive roles of fecal testing (e.g., fecal immunochemical testing for hemoglobin) and CTC. The use of CEA, CT scans of the liver, as well as chest radiographs are beyond the scope of this document and are not reviewed. The goal of this consensus document is to provide a critical review of the literature and recommendations regarding the role of colonoscopy, flexible sigmoidoscopy, EUS, fecal testing, and CTC in surveillance after surgical resection of CRC.