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Metachronous colorectal cancer: A competing risks analysis with consideration for a stratified approach to surveillance colonoscopy
Author(s) -
Battersby Nicholas J.,
Coupland Alex,
Bouliotis George,
Mirza Nazzia,
Williams J. Graham
Publication year - 2014
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.23504
Subject(s) - medicine , colonoscopy , colorectal cancer , asymptomatic , population , incidence (geometry) , cancer , cumulative incidence , polypectomy , surgery , general surgery , transplantation , physics , environmental health , optics
Background The incidence of metachronous cancer will become an important clinical consideration as the life expectancy of the population increases and as rates of curative resection improve. Objective To assess the pattern of metachronous cancer development following curative resection of colorectal cancer in an unselected patient population offered postoperative colonoscopic surveillance. Method Prospective clinical follow‐up after curative colorectal cancer resection and surveillance colonoscopy with or without polypectomy in accordance with the national guidelines. Actuarial analysis and competing risk analysis were performed to account for death and recurrence and to stratify for age, gender, stage, and tumor site. Results Five hundred thirty‐eight patients with median follow‐up 4 years 2 month (0–16) years. Fifteen patients (3%) developed metachronous cancer, at a median time interval of 90 months from primary resection. Thirteen metachronous cancer patients (87%, 13/15) underwent one to five surveillance colonoscopies: nine patients were asymptomatic at time of diagnosis of metachronous cancer. Competing risks analysis suggests that the adjusted cumulative incidence in males aged 55 is 4% at 10 years compared with 1% in females aged 85 years old. Conclusions A patient aged under 65 at the time of the primary curative resection carries a 2% 5‐year risk of metachronous cancer, implying that 3 year surveillance colonoscopy is justified. Whereas patients aged over 75 carry less than a 2% 10‐year risk, implying that it is seldom warranted to repeat the colonoscopy more frequently than every 5 years. A stratified approach to the frequency of surveillance colonoscopy requires further consideration. J. Surg. Oncol. 2014 109:445–450 . © 2013 Wiley Periodicals, Inc.