Is colonoscopic surveillance necessary after curative resection of colorectal cancer in elderly patients?

Background: Surveillance colonoscopy is routinely offered to patients who have undergone curative resections for colorectal cancer (CRC). The purpose of this study is to investigate the early detection of metachronous tumors or anastomotic recurrences. Few studies have investigated the utility of surveillance scopes in the elderly population. Objective: To investigate the incidence of metachronous cancer or anastomotic recurrence in patients over the age of 80 years who underwent resection of CRC with curative intent. Design: This is a retrospective study of a prospectively maintained database. Setting: University Hospital Geelong. Patients and Methods: All patients ≥80 years of age who underwent resection of CRC with curative intent at University Hospital Geelong between January 2002 and December 2014 were studied. Demographic information, comorbidities (Charlson score), types of surgery, postoperative complications (Clavien–Dindo), tumor staging, and details regarding postoperative colonoscopies were recorded. Patients were followed up for life whenever possible. The mean length of hospital stay and follow-up were determined. Survival analysis was done using the Kaplan–Meier method. The incidence of metachronous and locally recurrent CRC was calculated. Main Outcome Measures: Incidence of metachronous or locally recurrent CRC. Sample Size: One hundred and eighty-three patients. Results: Ninety-nine patients (54%) were female and 147 (80%) had elective resections. Seventy-one (39%) patients had moderate-to-severe comorbidities (Charlson Comorbidity Index ≥3). There were 139 patients who had had colon cancer and 44 with rectal cancer who had been resected with curative intent. Stages I, II, and III cancers comprised 16%, 47%, and 37%, respectively. The mean length of hospital stay was 13.3 days. The mean duration of follow-up was 3.43 years. Median survival after surgery by stage was 93 months (Stage I), 92 months (Stage II), and 72 months (Stage III). A total of 26 surveillance colonoscopies were performed on 24 patients. After a total of 627.21 patient-years of follow up, one metachronous CRC was detected, but no local recurrences were observed. Conclusion: It is extremely uncommon to detect clinically significant metachronous tumors in patients aged over 80. Limitation: Small cohort size. Conflict of Interest: None.