Guidelines for Colonoscopy Surveillance After Cancer Resection

A Consensus Update by the American Cancer Society and the US Multi-Society Task Force on Colorectal Cancer

Douglas K. Rex, Charles J. Kahi, Bernard Levin, Robert A. Smith, John H. Bond, Durado Brooks, Randall W. Burt, Tim Byers, Robert H. Fletcher, Neil Hyman, David Johnson, Lynne Kirk, David Lieberman, Theodore R. Levin, Michael J. O'Brien, Clifford Simmang, Alan G. Thorson, Sidney J. Winawer

Research output: Contribution to journalArticle

237 Citations (Scopus)

Abstract

Patients with resected colorectal cancer are at risk for recurrent cancer and metachronous neoplasms in the colon. This joint update of guidelines by the American Cancer Society and the US Multi-Society Task Force on Colorectal Cancer addresses only the use of endoscopy in the surveillance of these patients. Patients with endoscopically resected Stage I colorectal cancer, surgically resected Stages II and III cancers, and Stage IV cancer resected for cure (isolated hepatic or pulmonary metastasis) are candidates for endoscopic surveillance. The colorectum should be carefully cleared of synchronous neoplasia in the perioperative period. In nonobstructed colons, colonoscopy should be performed preoperatively. In obstructed colons, double-contrast barium enema or computed tomography colonography should be performed preoperatively, and colonoscopy should be performed 3 to 6 months after surgery. These steps complete the process of clearing synchronous disease. After clearing for synchronous disease, another colonoscopy should be performed in 1 year to look for metachronous lesions. This recommendation is based on reports of a high incidence of apparently metachronous second cancers in the first 2 years after resection. If the examination at 1 year is normal, then the interval before the next subsequent examination should be 3 years. If that examination is normal, then the interval before the next subsequent examination should be 5 years. Shorter intervals may be indicated by associated adenoma findings (see "Guidelines for Colonoscopy Surveillance After Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society"). Shorter intervals also are indicated if the patient's age, family history, or tumor testing indicate definite or probable hereditary nonpolyposis colorectal cancer. Patients undergoing low anterior resection of rectal cancer generally have higher rates of local cancer recurrence compared with those with colon cancer. Although effectiveness is not proven, performance of endoscopic ultrasound or flexible sigmoidoscopy at 3- to 6-month intervals for the first 2 years after resection can be considered for the purpose of detecting a surgically curable recurrence of the original rectal cancer.

Original languageEnglish (US)
Pages (from-to)1865-1871
Number of pages7
JournalGastroenterology
Volume130
Issue number6
DOIs
StatePublished - Jun 2006

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Advisory Committees
Colonoscopy
Colorectal Neoplasms
Guidelines
Neoplasms
Colon
Second Primary Neoplasms
Rectal Neoplasms
Hereditary Nonpolyposis Colorectal Neoplasms
Sigmoidoscopy
Recurrence
Perioperative Period
Adenoma
Colonic Neoplasms
Endoscopy
Consensus
Joints
Tomography
Neoplasm Metastasis
Lung

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Guidelines for Colonoscopy Surveillance After Cancer Resection : A Consensus Update by the American Cancer Society and the US Multi-Society Task Force on Colorectal Cancer. / Rex, Douglas K.; Kahi, Charles J.; Levin, Bernard; Smith, Robert A.; Bond, John H.; Brooks, Durado; Burt, Randall W.; Byers, Tim; Fletcher, Robert H.; Hyman, Neil; Johnson, David; Kirk, Lynne; Lieberman, David; Levin, Theodore R.; O'Brien, Michael J.; Simmang, Clifford; Thorson, Alan G.; Winawer, Sidney J.

In: Gastroenterology, Vol. 130, No. 6, 06.2006, p. 1865-1871.

Research output: Contribution to journalArticle

Rex, DK, Kahi, CJ, Levin, B, Smith, RA, Bond, JH, Brooks, D, Burt, RW, Byers, T, Fletcher, RH, Hyman, N, Johnson, D, Kirk, L, Lieberman, D, Levin, TR, O'Brien, MJ, Simmang, C, Thorson, AG & Winawer, SJ 2006, 'Guidelines for Colonoscopy Surveillance After Cancer Resection: A Consensus Update by the American Cancer Society and the US Multi-Society Task Force on Colorectal Cancer', Gastroenterology, vol. 130, no. 6, pp. 1865-1871. https://doi.org/10.1053/j.gastro.2006.03.013
Rex, Douglas K. ; Kahi, Charles J. ; Levin, Bernard ; Smith, Robert A. ; Bond, John H. ; Brooks, Durado ; Burt, Randall W. ; Byers, Tim ; Fletcher, Robert H. ; Hyman, Neil ; Johnson, David ; Kirk, Lynne ; Lieberman, David ; Levin, Theodore R. ; O'Brien, Michael J. ; Simmang, Clifford ; Thorson, Alan G. ; Winawer, Sidney J. / Guidelines for Colonoscopy Surveillance After Cancer Resection : A Consensus Update by the American Cancer Society and the US Multi-Society Task Force on Colorectal Cancer. In: Gastroenterology. 2006 ; Vol. 130, No. 6. pp. 1865-1871.
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