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World Journal of Surgical Oncology
Published in: World Journal of Surgical Oncology 1/2021

Open Access 01-12-2021 | Magnetic Resonance Imaging | Research

Efficacy of endoscopic surveillance in the detection of local recurrence after radical rectal cancer surgery is limited? A retrospective study

Authors: Michal Jankowski, Wojciech M. Wysocki, Manuela Las-Jankowska, Karol Tkaczyński, Dorian Wiśniewski, Dariusz Bała, Wojciech Zegarski

Published in: World Journal of Surgical Oncology | Issue 1/2021

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Abstract

Background

Rectal cancer, one of most common neoplasms, is characterized by an overall survival rate exceeding 60%. Nonetheless, local recurrence (LR) following surgery for rectal cancer remains a formidable clinical problem. The aim of this study was to assess the value of postoperative endoscopic surveillance (PES) for the early detection of LR in rectal cancer after radical anterior resection with sigmoid-rectal anastomosis.

Methods

We performed an anterior resection in 228 patients with stages I‑III rectal cancer who had undergone surgery from 2001 to 2008 in the Oncology Center in Bydgoszcz, Poland. Of these patients, 169 had perioperative radiotherapy or radiochemotherapy. All patients underwent PES with abdominal and pelvic imaging (abdominal ultrasound, computed tomography, magnetic resonance) and clinical examination. Sensitivities, specificities, positive likelihood ratios, negative likelihood ratios, and receiver operating characteristic curves were calculated to compare the value of colonoscopy versus imaging techniques for the diagnosis of LR.

Results

During the 5-year follow-up, recurrences occurred in 49 (21%) patients; of these, 15 (6%) had LR, which was most often located outside the intestinal lumen (n = 10, 4%). Anastomotic LR occurred in 5 (2%) patients. The mean time to anastomotic LR was 30 months after initial surgery, similar to that of other locations (29 months). Both imaging and endoscopy were shown to be efficient techniques for the diagnosis of LR in anastomotic sites. In the study group, endoscopy did not provide any additional benefit in patients who were receiving radiation therapy.

Conclusions

The benefit of PES for the detection of LR after curative treatment of rectal cancer is limited and not superior to imaging techniques. It remains a useful method, however, for the histopathological confirmation of suspected or confirmed recurrence.
Appendix
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Literature
1.
Arnold M, Sierra MS, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global patterns and trends in colorectal cancer incidence and mortality. Gut. 2017;66:683–91.PubMedCrossRef
2.
Noone AM, Howlader N, Krapcho M, Miller D, Brest A, Yu M, et al. (eds). SEER cancer statistics review, 1975-2015. Bethesda: National Cancer Institute. https://​seer.​cancer.​gov/​csr/​1975_​2015/​, based on November 2017 SEER data submission, posted to the SEER web site, April 2018. Accessed 10 Dec 2020.
3.
Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55:74–108.PubMedCrossRef
4.
5.
Silberfein EJ, Kattepogu KM, Hu CY, Skibber JM, Rodriguez-Bigas MA, Feig B, et al. Long-term survival and recurrence outcomes following surgery for distal rectal cancer. Ann Surg Oncol. 2010;17:2863–9.PubMedPubMedCentralCrossRef
6.
Joseph DA, Johnson CJ, White A, Wu M, Coleman MP. Rectal cancer survival in the United States by race and stage, 2001 to 2009: findings from the CONCORD-2 study. Cancer. 2017;123:5037–58.PubMedCrossRef
7.
Gilardoni E, Bernasconi DP, Poli S, Garancini M, Luperto M, Zucchini N, et al. Surveillance for early stages of colon cancer: potentials for optimizing follow-up protocols. World J Surg Oncol. 2015;13:260.PubMedPubMedCentralCrossRef
8.
Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet. 1986;1:1479–82.PubMedCrossRef
9.
Quirke P, Durdey P, Dixon MF, Williams NS. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection: histopathological study of lateral tumour spread and surgical excision. Lancet. 1986;2:996–9.PubMedCrossRef
10.
Swedish Rectal Cancer Trial, Cedermark B, Dahlberg M, Glimelius B, Påhlman L, Rutqvist LE, et al. Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med. 1997;336:980–7.CrossRef
11.
Akgun E, Ozkok S, Tekin M, Yoldas T, Caliskan C, Kose T, et al. The effects of chemoradiotherapy on recurrence and survival in locally advanced rectal cancers with curative total mesorectal excision: a prospective, nonrandomized study. World J Surg Oncol. 2017;15:205.PubMedPubMedCentralCrossRef
12.
Westberg K, Palmer G, Hjern F, Johansson H, Holm T, Martling A. Management and prognosis of locally recurrent rectal cancer: a national population-based study. Eur J Surg Oncol. 2018;44:100–7.PubMedCrossRef
13.
Guadagni S, Fiorentini G, De Simone M, Masedu F, Zoras O, Mackay AR, et al. Precision oncotherapy based on liquid biopsies in multidisciplinary treatment of unresectable recurrent rectal cancer: a retrospective cohort study. J Canc Res Clin Oncol. 2020;146:205–19.CrossRef
14.
Rodriguez-Moranta F, Salo J, Arcusa A, Boadas J, Piñol V, Bessa X, et al. Postoperative surveillance in patients with colorectal cancer who have undergone curative resection: a prospective, multicenter, randomized, controlled trial. J Clin Oncol. 2006;24:386–93.PubMedCrossRef
15.
Pfister DG, Benson AB III, Somerfield MR. Surveillance strategies after curative treatment of colorectal cancer. N Engl J Med. 2004;350:2375–82.PubMedCrossRef
16.
Jeffery M, Hickey BE, Hider PN, See AM. Follow-up strategies for patients treated for non-metastatic colorectal cancer. Cochrane Database Syst Rev. 2016;11:CD002200 [update in Cochrane Database Syst Rev. 2019;11(11):CD002200].PubMed
17.
Hassan C, Wysocki PT, Fuccio L, Seufferlein T, Dinis-Ribeiro M, Brandão C, et al. Endoscopic surveillance after surgical or endoscopic resection for colorectal cancer: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Digestive Oncology (ESDO) Guideline. Endoscopy. 2019;51:266–77.PubMedCrossRef
18.
Greene FL, Page DL, Fleming ID, et al., editors. AJCC cancer staging manual. 6th ed. Berlin: Springer-Verlag; 2002.
19.
Höcht S, Mann B, Germer CT, Hammad R, Siegmann A, Wiegel T, et al. Pelvic sidewall involvement in recurrent rectal cancer. Int J Colorectal Dis. 2004;19:108–13.PubMedCrossRef
20.
Andreoni B, Chiappa A, Bertani E, Bellomi M, Orecchia R, Zampino M, et al. Surgical outcomes for colon and rectal cancer over a decade: results from a consecutive monocentric experience in 902 unselected patients. World J Surg Oncol. 2007;5:73.PubMedPubMedCentralCrossRef
21.
van den Berg I, Coebergh van den Braak RRJ, van Vugt JLA, Ijzermans JNM, Buettner S. Actual survival after resection of primary colorectal cancer: results from a prospective multicenter study. World J Surg Oncol. 2021;19:96.PubMedPubMedCentralCrossRef
22.
Kahi CJ, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, et al. Colonoscopy surveillance after colorectal cancer resection: recommendations of the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2016;150:758–768.e11.PubMedCrossRef
23.
Pickhardt PJ, Edwards K, Bruining DH, Gollub M, Kupfer S, Lubner SJ, et al. Prospective trial evaluating the surgical anastomosis at one-year colorectal cancer surveillance: CT colonography versus optical colonoscopy and implications for patient care. Dis Colon Rectum. 2017;60:1162–7.PubMedPubMedCentralCrossRef
24.
Choi YJ, Park SH, Lee SS, et al. CT colonography for follow-up after surgery for colorectal cancer. AJR Am J Roentgenol. 2007;189:283–9.PubMedCrossRef
25.
Farhat W, Azzaza M, Mizouni A, Ammar H, Ben Ltaifa M, Lagha S, et al. Factors predicting recurrence after curative resection for rectal cancer: a 16-year study. World J Surg Oncol. 2019;17:173.PubMedPubMedCentralCrossRef
26.
Fuccio L, Rex D, Ponchon T, Frazzoni L, Dinis-Ribeiro M, Bhandari P, et al. New and recurrent colorectal cancers after resection: a systematic review and meta-analysis of endoscopic surveillance studies. Gastroenterology. 2019;156:1309–1323.e3.PubMedCrossRef
27.
Yun JA, Huh JW, Kim HC, Park YA, Cho YB, Yun SH, et al. Local recurrence after curative resection for rectal carcinoma: the role of surgical resection. Medicine (Baltimore). 2016;95:e3942.CrossRef
28.
Van Gijn W, Marijnej CA, Nagtegaal ID, Kranenbarg EM, Putter H, Wiggers T, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12 year follow-up of the multicentre, randomized controlled TME trial. Lancet Oncol. 2011;12:575–82.PubMedCrossRef
29.
Zhao GH, Deng L, Ye DM, Wang WH, Yan Y, Yu T. Efficacy and safety of wait and see strategy versus radical surgery and local excision for rectal cancer with cCR response after neoadjuvant chemoradiotherapy: a meta-analysis. World J Surg Oncol. 2020;18:232.PubMedPubMedCentralCrossRef
30.
31.
Feeney G, Sehgal R, Sheehan M, Hogan A, Regan M, Joyce M, et al. Neoadjuvant radiotherapy for rectal cancer management. World J Gastroenterol. 2019;25:4850–69.PubMedPubMedCentralCrossRef
32.
Palmer G, Martling A, Cedermark B, Holm T. A population-based study on the management and outcome in patients with locally recurrent rectal cancer. Ann Surg Oncol. 2007;14:447–54.PubMedCrossRef
33.
Moore HG, Shoup M, Riedel E, Minsky BD, Alektiar KM, Ercolani M, et al. Colorectal cancer pelvic recurrences: determinants of resectability. Dis Colon Rectum. 2004;47:1599–606.PubMedCrossRef
34.
Glimelius B, Groenberg H, Jarhult J, Wallgren A, Cavallin-Ståhl E. A systematic overview of radiation therapy effects in rectal cancer. Acta Oncol. 2003;42:476–92.PubMedCrossRef
35.
Kusters M, Marijnen CA, van de Velde CJ, Rutten HJ, Lahaye MJ, Kim JH, et al. Patterns of local recurrence in rectal cancer: a study of the Dutch TME trial. Eur J Surg Oncol. 2010;36:470–6.PubMedCrossRef
36.
Braendengen M, Tveit KM, Berglund A, Birkemeyer E, Frykholm G, Påhlman L, et al. Randomized phase III study comparing preoperative radiotherapy with chemoradiotherapy in nonresectable rectal cancer. J Clin Oncol. 2008;26:3687–94.PubMedCrossRef
37.
Ciseł B, Pietrzak L, Michalski W, Wyrwicz L, Rutkowski A, Kosakowska E, et al. Long-course preoperative chemoradiation versus 5 × 5 Gy and consolidation chemotherapy for clinical T4 and fixed clinical T3 rectal cancer: long-term results of the randomized Polish II study. Ann Oncol. 2019;30:1298–303.PubMedCrossRef
38.
Jankowski M, Las-Jankowska M, Bala D, Zegarski W. The role of postoperative chemotherapy in patients who undergoing surgery following chemoradiotherapy of initially unresectable rectal cancer. Nowotwory J Oncol. 2017;67:281–4.CrossRef
39.
Kosakowska E, Pietrzak L, Michalski W, Kepka L, Polkowski W, Jankiewicz M, et al. Neoadjuvant chemotherapy with or without oxaliplatin after short-course radiotherapy in high-risk rectal cancer: a subgroup analysis from a prospective study. Rep Pract Oncol Radiother. 2020;25:1017–22.PubMedCrossRef
40.
Pinol V, Andreu M, Castells A, Payá A, Bessa X, Jover R. Synchronous colorectal neoplasms in patients with colorectal cancer: predisposing individual and familial factors. Dis Colon Rectum. 2004;47:1192–200.PubMedCrossRef
41.
Mulder SA, Kranse R, Damhuis RA, de Wilt JH, Ouwendijk RJ, Kuipers EJ, et al. Prevalence and prognosis of synchronous colorectal cancer: a Dutch population-based study. Cancer Epidemiol. 2011;35:442–7.PubMedCrossRef
42.
Green RJ, Metlay JP, Propert K, Catalano PJ, Macdonald JS, Mayer RJ, et al. Surveillance for second primary colorectal cancer after adjuvant chemotherapy: an analysis of Intergroup 0089. Ann Intern Med. 2002;136:261–9.PubMedCrossRef
43.
le Clercq CM, Winkens B, Bakker CM, Keulen ET, Beets GL, Masclee AA, et al. Metachronous colorectal cancers result from missed lesions and non-compliance with surveillance. Gastrointest Endosc. 2015;82:325–333.e2.PubMedCrossRef
44.
Liu L, Lemmens VE, De Hingh IH, de Vries E, Roukema JA, van Leerdam ME, et al. Second primary cancers in subsites of colon and rectum in patients with previous colorectal cancer. Dis Colon Rectum. 2013;56:158–68.PubMedCrossRef
45.
Lee SY, Kim BC, Han KS, Hong CW, Sohn DK, Park SC, et al. Incidence and risk factors of metachronous colorectal neoplasm after curative resection of colorectal cancer in Korean patients. J Dig Dis. 2014;15:367–76.PubMedCrossRef
46.
Cubiella J, Gomez R, Sanchez E, Díez MS, Vega M. Endoscopic follow-up of patients after curative surgery for colorectal cancer: results of a medical assistance protocol. Rev Esp Enferm Dig. 2003;95:278–81 273-7.PubMed
47.
Matsuda T, Fujii T, Sano Y, Kudo SE, Oda Y, Igarashi M, et al. Five-year incidence of advanced neoplasia after initial colonoscopy in Japan: a multicenter retrospective cohort study. Jpn J Clin Oncol. 2009;39:435–42.PubMedCrossRef
48.
Yoshida N, Naito Y, Siah KT, Murakami T, Ogiso K, Hirose R, et al. High incidence of metachronous advanced adenoma and cancer after endoscopic resection of colon polyps ≥20 mm in size. Dig Endosc. 2016;28:194–202.PubMedCrossRef
49.
Chau I, Allen MJ, Cunningham D, Norman AR, Brown G, Ford HE, et al. The value of routine serum carcinoembryonic antigen measurement and computed tomography in the surveillance of patients after adjuvant chemotherapy for colorectal cancer. J Clin Oncol. 2004;22:1420–9.PubMedCrossRef
50.
Ganeshan D, Nougaret S, Korngold E, Rauch GM, Moreno CC. Locally recurrent rectal cancer: what the radiologist should know. Abdom Radiol (NY). 2019;44:3709–25.CrossRef
51.
Molinelli V, Angeretti MG, Duka E, Tarallo N, Bracchi E, Novario R, et al. Role of MRI and added value of diffusion-weighted and gadolinium-enhanced MRI for the diagnosis of local recurrence from rectal cancer. Abdom Radiol (NY). 2018;43:2903–12.CrossRef
52.
Tan PL, Chan CL, Moore NR. Radiological appearances in the pelvis following rectal cancer surgery. Clin Radiol. 2005;60:846–55.PubMedCrossRef
53.
Abdel Razek AAK. Arterial spin labelling and diffusion-weighted magnetic resonance imaging in differentiation of recurrent head and neck cancer from post-radiation changes. J Laryngol Otol. 2018;132:923–8.PubMedCrossRef
54.
Snyder RA, Hu C, Cuddy A, Francescatti AB, Schumacher JR, Van Loon K, et al. Association between intensity of posttreatment surveillance testing and detection of recurrence in patients with colorectal cancer. JAMA. 2018;319:2104–15.PubMedPubMedCentralCrossRef
55.
Wille-Jørgensen P, Syk I, Smedh K, Laurberg S, Nielsen DT, Petersen SH, et al. Effect of more vs less frequent follow-up testing on overall and colorectal cancer-specific mortality in patients with stage II or III colorectal cancer: the COLOFOL randomized clinical trial. JAMA. 2018;319:2095–103.PubMedPubMedCentralCrossRef
56.
Liu SL, Cheung WY. Role of surveillance imaging and endoscopy in colorectal cancer follow-up: quality over quantity? World J Gastroenterol. 2019;25:59–68.PubMedPubMedCentralCrossRef
57.
Pita-Fernandez S, Alhayek-Ai M, Gonzalez-Martin C, López-Calviño B, Seoane-Pillado T, Pértega-Díaz S. Intensive follow-up strategies improve outcomes in nonmetastatic colorectal cancer patients after curative surgery: a systematic review and metaanalysis. Ann Oncol. 2015;26:644–56.PubMedCrossRef
58.
Rex DK, Kahi CJ, Levin B, Smith RA, Bond JH, Brooks D, et al. Guidelines for colonoscopy surveillance after cancer resection: a consensus update by the American Cancer Society and US Multi-Society Task Force on Colorectal Cancer. CA Cancer J Clin. 2006;56:160–7.PubMedCrossRef
59.
Jassem J, Duchnowska R, Kawecki A, Krajewski R, Krzakowski M, Mądry R, et al. Post-treatment surveillance in most common solid malignancies in adults. Nowotwory J Oncol. 2014;64:415–35.CrossRef
60.
Glynne-Jones R, Wyrwicz L, Tiret E, Brown G, Rödel C, Cervantes A, et al. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017;28:iv22–40.PubMedCrossRef
61.
62.
Rödel C, Liersch T, Becker H, Fietkau R, Hohenberger W, Hothorn T, et al. Preoperative chemoradiotherapy and postoperative chemotherapy with fluorouracil and oxaliplatin versus fluorouracil alone in locally advanced rectal cancer: initial results of the German CAO/ARO/AIO-04 randomised phase 3 trial. Lancet Oncol. 2012;13:679–87.PubMedCrossRef
63.
Erlandsson J, Holm T, Pettersson D, Berglund Å, Cedermark B, Radu C, et al. Optimal fractionation of preoperative radiotherapy and timing to surgery for rectal cancer (Stockholm III): a multicentre, randomised, non-blinded, phase 3, non-inferiority trial. Lancet Oncol. 2017;18:336–46.PubMedCrossRef
64.
Jankowski M, Bała D, Las-Jankowska M, Wysocki WM, Nowikiewicz T, Zegarski W. Overall treatment outcome - analysis of long-term results of rectal cancer treatment on the basis of a new parameter. Arch Med Sci. 2020;16:825–33.PubMedPubMedCentralCrossRef
65.
Jørgensen JB, Bondeven P, Iversen LH, Laurberg S, Pedersen BG. Pelvic insufficiency fractures frequently occur following preoperative chemo-radiotherapy for rectal cancer - a nationwide MRI study. Colorectal Dis. 2018;20:873–80.PubMedCrossRef
66.
ASGE Standards of Practice Committee, Fisher DA, Maple JT, Ben-Menachem T, Cash BD, Decker GA, et al. Complications of colonoscopy. Gastrointest Endosc. 2011;74:745–52.CrossRef
Metadata
Title
Efficacy of endoscopic surveillance in the detection of local recurrence after radical rectal cancer surgery is limited? A retrospective study
Authors
Michal Jankowski
Wojciech M. Wysocki
Manuela Las-Jankowska
Karol Tkaczyński
Dorian Wiśniewski
Dariusz Bała
Wojciech Zegarski
Publication date
01-12-2021

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