Endoscopic surveillance after surgical or endoscopic resection for colorectal cancer: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Digestive Oncology (ESDO) Guideline

Abstract

Main Recommendations 1 We recommend post-surgery endoscopic surveillance for CRC patients after intent-to-cure surgery and appropriate oncological treatment for both local and distant disease.Strong recommendation, low quality evidence. 2 We recommend a high quality perioperative colonoscopy before surgery for CRC or within 6 months following surgery.Strong recommendation, low quality evidence. 3 We recommend performing surveillance colonoscopy 1 year after CRC surgery.Strong recommendation, moderate quality evidence. 4 We do not recommend an intensive endoscopic surveillance strategy, e. g. annual colonoscopy, because of a lack of proven benefit.Strong recommendation, moderate quality evidence. 5 After the first surveillance colonoscopy following CRC surgery, we suggest the second colonoscopy should be performed 3 years later, and the third 5 years after the second. If additional high risk neoplastic lesions are detected, subsequent surveillance examinations at shorter intervals may be considered.Weak recommendation, low quality evidence. 6 After the initial surveillance colonoscopy, we suggest halting post-surgery endoscopic surveillance at the age of 80 years, or earlier if life-expectancy is thought to be limited by comorbidities.Weak recommendation, low quality evidence. 7 In patients with a low risk pT1 CRC treated by endoscopy with an R0 resection, we suggest the same endoscopic surveillance schedule as for any CRC.Weak recommendation, low quality evidence.

British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post-polypectomy and post-colorectal cancer resection surveillance guidelines

“…Three studies presented evidence per age group relative to the younger age group. Martinez et al 12 reported statistically significant increased risks for AN across three age groups (61–71; 80+years) compared with the younger age group (50–59 years), with incidence of AA at first surveillance as 12.2%, 14.5%, and 17.7%, respectively. Furthermore, Martinez et al also presented evidence on the younger than 40 age group, and the 40–49 age group relative to the 50–59 age group.…”

“…The risk of metachronous cancer development is highest in the first 3 years after diagnosis of CRC 66 70. This increased risk is particularly common in older studies or in those where perioperative colonoscopy was not systematically performed 70.…”

“…The risk of metachronous cancer development is highest in the first 3 years after diagnosis of CRC 66 70. This increased risk is particularly common in older studies or in those where perioperative colonoscopy was not systematically performed 70. The risk of metachronous CRC compared with the general population appears to be of the same magnitude as that following resection of high-risk precancerous lesions 70.…”

“…This increased risk is particularly common in older studies or in those where perioperative colonoscopy was not systematically performed 70. The risk of metachronous CRC compared with the general population appears to be of the same magnitude as that following resection of high-risk precancerous lesions 70. Hence it seems logical, once a high quality postoperative clearance colonoscopy has been performed, that further follow-up should be determined in accordance with the post-polypectomy surveillance guidelines schedule.…”

COVID-19 and endoscopy: implications for healthcare and digestive cancer screening

“…In a large retrospective cohort study from the UK evaluating the effectiveness of post-polypectomy colonoscopy surveillance on incident colorectal cancer, Cross et al reported that, compared with the general population, CRC incidence without surveillance was similar among low-risk and intermediate-risk groups, but significantly higher in the high-risk group. However, a possible exception is the need for early colonoscopy surveillance following complex polyp resection (for example, endoscopic mucosal resection or endoscopic submucosal dissection) or following endoscopic management of early gastric cancer because these patients have been shown to be at high-risk for residual or recurrent disease 9,10 . Delays for endoscopic surveillance are now common owing to endoscopy units temporarily suspending such procedures, a lack of endoscopy personnel to perform these procedures as many have been assigned to other medical wards to care for patients with COVID-19 or are sick or isolating themselves, or because patients decide to stay away from hospitals.…”