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.