Rex Douglas K, Kahi Charles J, Levin Bernard, Smith Robert A, Bond John H, Brooks Durado, Burt Randall W, Byers Tim, Fletcher Robert H, Hyman Neil, Johnson David, Kirk Lynne, Lieberman David A, Levin Theodore R, O'Brien Michael J, Simmang Clifford, Thorson Alan G, Winawer Sidney J
Indiana University School of Medicine, Indianapolis, Indiana, USA.
Gastroenterology. 2006 May;130(6):1865-71. doi: 10.1053/j.gastro.2006.03.013.
Patients with resected colorectal cancer are at risk for recurrent cancer and metachronous neoplasms in the colon. This joint update of guidelines by the American Cancer Society and the US Multi-Society Task Force on Colorectal Cancer addresses only the use of endoscopy in the surveillance of these patients. Patients with endoscopically resected Stage I colorectal cancer, surgically resected Stages II and III cancers, and Stage IV cancer resected for cure (isolated hepatic or pulmonary metastasis) are candidates for endoscopic surveillance. The colorectum should be carefully cleared of synchronous neoplasia in the perioperative period. In nonobstructed colons, colonoscopy should be performed preoperatively. In obstructed colons, double-contrast barium enema or computed tomography colonography should be performed preoperatively, and colonoscopy should be performed 3 to 6 months after surgery. These steps complete the process of clearing synchronous disease. After clearing for synchronous disease, another colonoscopy should be performed in 1 year to look for metachronous lesions. This recommendation is based on reports of a high incidence of apparently metachronous second cancers in the first 2 years after resection. If the examination at 1 year is normal, then the interval before the next subsequent examination should be 3 years. If that examination is normal, then the interval before the next subsequent examination should be 5 years. Shorter intervals may be indicated by associated adenoma findings (see "Guidelines for Colonoscopy Surveillance After Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society"). Shorter intervals also are indicated if the patient's age, family history, or tumor testing indicate definite or probable hereditary nonpolyposis colorectal cancer. Patients undergoing low anterior resection of rectal cancer generally have higher rates of local cancer recurrence compared with those with colon cancer. Although effectiveness is not proven, performance of endoscopic ultrasound or flexible sigmoidoscopy at 3- to 6-month intervals for the first 2 years after resection can be considered for the purpose of detecting a surgically curable recurrence of the original rectal cancer.
接受过结直肠癌切除术的患者有发生癌症复发及结肠异时性肿瘤的风险。美国癌症协会和美国结直肠癌多学会特别工作组联合更新的指南仅涉及在内镜检查在这些患者监测中的应用。接受内镜切除的Ⅰ期结直肠癌患者、接受手术切除的Ⅱ期和Ⅲ期癌症患者以及因治愈目的而切除的Ⅳ期癌症（孤立性肝或肺转移）患者均为内镜监测的对象。在围手术期应仔细清除结直肠的同步肿瘤。在无梗阻的结肠，应在术前进行结肠镜检查。在梗阻性结肠，术前应进行双重对比钡剂灌肠或计算机断层结肠成像，术后3至6个月应进行结肠镜检查。这些步骤完成了清除同步疾病的过程。清除同步疾病后，应在1年内再次进行结肠镜检查以寻找异时性病变。这一建议基于切除术后头2年明显异时性第二癌症高发的报告。如果1年时的检查正常，那么下一次后续检查前的间隔应为3年。如果该检查正常，那么下一次后续检查前的间隔应为5年。相关腺瘤发现（见“息肉切除术后结肠镜监测指南：美国结直肠癌多学会特别工作组和美国癌症协会的共识更新”）可能表明需要更短的间隔时间。如果患者的年龄、家族史或肿瘤检测表明为明确或可能的遗传性非息肉病性结直肠癌，也需要更短的间隔时间。与结肠癌患者相比，接受直肠癌低位前切除术的患者局部癌症复发率通常更高。虽然效果尚未得到证实，但在切除术后的头2年，为了检测原发性直肠癌可手术治愈的复发情况，可考虑每隔3至6个月进行一次内镜超声或乙状结肠镜检查。
