New Evidence Supports Surveillance Colonoscopy for Patients With Stage I Colon Cancer
Douglas K. Rex, MD, FASGE, reviewing Hines RB, et al. Am J Gastroenterol 2020 Jan 31.
Gastroenterologists may be surprised to learn that some guideline groups do not endorse surveillance colonoscopy after resection of stage I colon cancer because of a lack of evidence of benefit.
In a retrospective cohort study of the Surveillance, Epidemiology, and End Results database combined with Medicare claims, 8783 colon cancer cases were analyzed. Failing to receive surveillance colonoscopy increased the hazard rate of colon cancer-specific death by 53% at 5 years, 63% at 10 years, and 89% in an analysis of 10-year conditional survival compared to patients who received 1 surveillance colonoscopy. Sensitivity analyses confirmed the beneficial effects of surveillance colonoscopy and indicated a negative effect on survival of failing to receive the first surveillance within 15 months of the initial cancer diagnosis. Surveillance colonoscopy was also associated with a reduction in noncancer-specific mortality.
COMMENT
Although there are limitations to a cohort study of this type, these data indicate a clear benefit for surveillance colonoscopy after stage I cancer resection, as recommended by most guideline groups, including the U.S. Multi-Society Task Force on Colorectal Cancer. The data also support the widespread recommendation to perform colonoscopy within 1 year after resection, which identifies missed synchronous cancer and advanced neoplasia.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Douglas K. Rex, MD, FASGE
CITATION(S)
Hines RB, Jiban MJH, Specogna AV, et al. Surveillance colonoscopy in older stage I colon cancer patients and the association with colon cancer-specific mortality. Am J Gastroenterol 2020 Jan 31. (Epub ahead of print) (http://dx.doi.org/10.14309/ajg.0000000000000537)
