Endoscopic surveillance after curative surgery for sporadic colorectal cancer: patient-tailored, tumor-targeted or biology-driven?

Abstract

Objective. Endoscopy has been endorsed and introduced in most surveillance programs following curative surgery for colorectal cancer (CRC), yet little data are available to support its use in terms of patient selection, efficacy and frequency of surveillance. Material and methods. A literature search in the English language using the PubMed/Medline database for the MeSH terms “colorectal cancer”, “surveillance”, and “endoscopy”, with focus on sporadic CRC, excluding CRC developed on a hereditary or inflammatory bowel disease background. Focus on results from the past 5 years was applied. Results. Recent systematic reviews, meta-analyses, randomized trials and prospective studies made the backbone of the article, supported by population-based findings and recent reports on tumor biology. Hard evidence to support a survival benefit from endoscopy alone is lacking. Definitions of “synchronous”, “interval”, and “metachronous” cancers are not uniform and hampers comparison of studies. The number of metachronous cancers (usually 2–4%) that develop after curative CRC surgery is small, and better patient-tailored surveillance could improve the diagnostic yield. Compliance with endoscopy is low compared to other modalities. Age and socio-demographic factors influence on the surveillance coverage and need to be addressed in any given program. The majority of local recurrences occur within the first 3 years after surgery independent of stage, and microsatellite instable (MSI) tumors appear to be at higher risk. Conclusions. Endoscopy in surveillance after curative surgery for CRC is a resource demanding procedure. A tailored approach according to factors associated with an increased risk for metachronous cancer/local recurrence would increase efficiency.

Key Words::

• Colorectal cancer
• colonoscopy
• compliance
• cost-benefit
• endoscopy
• genetic instability
• metastasis
• prognosis
• recurrence
• surveillance
• surgery

Declaration of interest: The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper.