Routine endoscopic surveillance for local recurrence of rectal cancer is futile

• Published in: The American journal of surgery Vol. 210; no. 6; pp. 996 - 1002
• Main Authors: Martin, Luke A., M.D, Gross, Molly E., M.D, Mone, Mary C., R.N., B.S.E, Whiting, Christopher K., B.S, Hansen, Heidi J, Mecham, Elise M., M.D, Peche, William, M.D, Scaife, Courtney L., M.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2015; Elsevier Limited
• Subjects: Adult; Aged; Aged, 80 and over; Antigens; Biomarkers, Tumor - blood; Carcinoembryonic Antigen - blood; Colleges & universities; Colorectal cancer; Costs; Disease; Endoscopy; Female; Humans; Local recurrence rectal cancer; Male; Metastasis; Middle Aged; Mortality; Neoplasm Recurrence, Local - diagnosis; Practice Guidelines as Topic; Proctoscopy; Rectal cancer; Rectal endoscopy; Rectal Neoplasms - pathology; Rectal Neoplasms - surgery; Rectal surveillance; Retrospective Studies; Sigmoidoscopy; Surgery; Surveillance; Tomography; Utah; Utah; Rectal surveillance; Local recurrence rectal cancer; Proctoscopy; Rectal cancer; Rectal endoscopy
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2015.06.027

Abstract Background National Comprehensive Cancer Network guidelines for rectal adenocarcinoma regarding routine surveillance with proctoscopy for local recurrence have been evolving. The purpose of this study was to examine the utility of rectal surveillance. Methods This is a single-center, retrospective review of patients (2004 to 2011) who underwent total mesorectal excision for rectal cancer. The primary end point was cancer recurrence, with detection method(s) noted. The number of surveillance procedures was collected. Results The study included 112 patients. There were no local recurrences identified by rectal surveillance. There were 1 local recurrence and 17 distant recurrences (16%). The local recurrence was identified by carcinoembryonic antigen and symptoms. There were 20 anoscopies, 44 proctoscopies, and 495 flexible sigmoidoscopies performed, with estimated charges of $266,000. Conclusions Rectal surveillance at this center was not beneficial. This study supports the recent (2015) change in the National Comprehensive Cancer Network guidelines, which no longer recommend routine rectal surveillance and challenge other society guidelines.