Evaluating the oncological value of extended colorectal cancer surveillance.

Abstract

Aims: To record the incidence of polyps, new primary tumours or other pathologies and thus evaluate the value of colorectal cancer (CRC) surveillance beyond standard 5-years period. The American Society of Colon and Rectal Surgeons (ASCRS) recommend surveillance for 5-years following colorectal cancer (CRC) resection. The oncological value of extended surveillance remains controversial.

Methods: A retrospective cohort study was performed. Patients who underwent curative surgery for CRC between 2004-2023 with endoscopic and commuted tomography (CT) surveillance were identified from a prospectively maintained database. A comprehensive review of electronic medical, endoscopic, and radiological records was performed. Descriptive statistics were preformed using SPSS v26.0.

Results: Overall, 217 patients were included, with overall incidence of polyps, new primary tumours and distant metastases discovered during surveillance were 33 (17.6%), 14 (7.4%), and 47 (26.7%) respectively. Of these, 2 patients (14.3%) diagnosed with new primary tumours were diagnosed after 5-years surveillance, as were 4 (9.2%) of those who developed distant metastases. Furthermore, 11 (33.3%) of polyps were detected after 5-years surveillance.

Discussion: The study suggests the possibility that current ASCRS guidelines may result in a proportion of pathology occurrence to be missed in surveillance. Ultimately, the provision of well-designed, prospective randomised clinical trials will be necessary to ratify and support any potentially practice changing results.