Yusoff Ian F, Hoffman Neville E, Ee Hooi C
Department of Gastroenterology, Sir Charles Gairdner Hospital, Verdun Street, Nedlands, Perth, Western Australia 6009, Australia.
ANZ J Surg. 2003 Jan-Feb;73(1-2):3-7. doi: 10.1046/j.1445-2197.2003.02619.x.
Intensive colonoscopic surveillance after resection of colorectal cancer (CRC) has been shown not to improve outcome. The National Health and Medical Research Council of Australia (NHMRC) has recently published guidelines recommending appropriate surveillance intervals after CRC resection. The aims of the present study were to assess current and past patterns of postoperative CRC surveillance and to determine the yield of neoplasia from such surveillance.
An audit was performed of all patients who underwent colonoscopy following surgical resection of CRC from 1989 to 2001. Two groups were assessed: (i) all patients undergoing surveillance colonoscopies; and (ii) all patients diagnosed with CRC at Sir Charles Gairdner Hospital (SCGH) who subsequently had postoperative colonoscopies. Patients who had their index colonoscopy at the study centre and who subsequently underwent surveillance colonoscopies were studied in detail. Yield for neoplasia, patterns of surveillance and concordance with NHMRC recommendations were determined.
There were 990 surveillance examinations performed and colorectal adenomas were identified in 184. However, only one case of recurrent cancer was detected. There were a total of 161 patients who had CRC diagnosed and underwent surveillance at SCGH. Of these patients, 75% underwent colonoscopy at 12 months after resection and 48% of these cases underwent a further examination within 12 months. Only 23% of examinations concurred with NHMRC recommendations and practice has not changed with release of these guidelines.
Resectable CRC recurrences are rarely detected at colonoscopic surveillance. Surveillance colonoscopies are -performed too frequently and release of NHMRC guidelines has failed to change practice.
结直肠癌（CRC）切除术后进行强化结肠镜监测并未显示能改善预后。澳大利亚国家卫生与医学研究委员会（NHMRC）最近发布了指南，推荐CRC切除术后的适当监测间隔。本研究的目的是评估当前和过去CRC术后监测的模式，并确定这种监测中肿瘤的检出率。
对1989年至2001年接受CRC手术切除后进行结肠镜检查的所有患者进行了一项审计。评估了两组：（i）所有接受监测结肠镜检查的患者；（ii）在查尔斯·盖尔德纳爵士医院（SCGH）被诊断为CRC且随后进行了术后结肠镜检查的所有患者。对在研究中心进行首次结肠镜检查且随后接受监测结肠镜检查的患者进行了详细研究。确定了肿瘤的检出率、监测模式以及与NHMRC建议的一致性。
共进行了990次监测检查，其中184例发现了结直肠腺瘤。然而，仅检测到1例复发性癌症。共有161例患者在SCGH被诊断为CRC并接受了监测。在这些患者中，75%在切除后12个月接受了结肠镜检查，其中48%的病例在12个月内进行了进一步检查。只有23%的检查符合NHMRC的建议，并且这些指南发布后实践并未改变。
在结肠镜监测中很少检测到可切除的CRC复发。监测结肠镜检查过于频繁进行，NHMRC指南的发布未能改变实践。
