Preoperative re-endoscopy in colorectal cancer patients: an institutional experience and analysis of influencing factors.

BACKGROUND

This study serves to establish the re-endoscopy rate in patients undergoing surgery for colorectal cancer (CRC) at a tertiary academic center and to identify significant factors that may influence the decision for preoperative re-endoscopy.

METHODS

A retrospective review of 341 consecutive patients undergoing elective surgical resection for CRC was performed from January 2008 to December 2011. Descriptive statistics were used to define the patient population and to establish the institutional re-endoscopy rate. In order to identify factors associated with re-endoscopy, univariate and multivariate analysis was performed using the chi square test and logistic regression modeling.

RESULTS

Patients within the two comparison groups had similar demographic profiles. Excluding patients where the primary endoscopist was the operating surgeon, 121 of 299 patients (40.5%) underwent re-endoscopy. The most common reasons for re-endoscopy included tattooing of the lesion in 55 patients (45.5%), surgical planning in 43 (35.5%), and repeated therapeutic attempts in 11 (9%). Significant factors associated with re-endoscopy included left-sided colon cancers (compared to right-sided lesions, P < 0.001), planned laparoscopic procedures (P = 0.011), and the absence of a tattoo on the first colonoscopy (P = 0.010). There was also a trend toward a reduction in re-endoscopy if the operating surgeon was consulted at the time of the initial endoscopy (P = 0.085). There was a clear trend toward increased laparoscopic procedures over the duration of the study (P < 0.001). Although this did not correlate with an increase in re-endoscopy, it did coincide with a significant increase in preoperative tattooing at the first colonoscopy (P < 0.001).

CONCLUSIONS

The repeat preoperative endoscopy rate in CRC patients was 40.5%. Re-endoscopy was associated with an initial failure to tattoo the lesion, left-sided colonic neoplasms, and a planned laparoscopic resection. Further research is needed to help identify which patients would benefit from re-endoscopy and where this may be safely omitted.