Barlow A P, Thompson M H
Department of Surgery, Southmead Hospital, Westbury-on-Trym, Bristol, UK.
Br J Surg. 1993 Jun;80(6):781-4. doi: 10.1002/bjs.1800800644.
A policy of selective colonoscopy after resection for colorectal cancer was evaluated to assess the benefit of detecting missed synchronous and metachronous tumours in patients under 70 years of age with a good prognosis, and the possible risk of missing such lesions in those not screened. With preoperative barium enema and palpation at laparotomy, synchronous cancers and adenomas were found in 2 and 28 per cent, respectively, of 275 consecutive patients undergoing resection. Eighty-five patients were selected for postoperative colonoscopy, which was repeated at least once in 32, there being a total of 60 repeat examinations. Adenomas, but no cancers, were found in 19 patients (22 per cent) on first screening, but on repeat colonoscopy early metachronous cancers were detected in three patients (9 per cent) and adenomas on 21 examinations (35 per cent). Only one of the patients followed by clinical examination developed a symptomatic tumour. This suggests that postoperative colonoscopy is unlikely to benefit the majority but may be extremely important for young fit patients with continuing polyp formation who are at high risk of developing metachronous cancer.
对一项针对结直肠癌切除术后选择性结肠镜检查的政策进行了评估，以评估在预后良好的70岁以下患者中检测漏诊的同时性和异时性肿瘤的益处，以及未接受筛查的患者漏诊此类病变的可能风险。在275例连续接受切除术的患者中，通过术前钡剂灌肠和剖腹探查触诊，分别发现2%的患者存在同时性癌，28%的患者存在同时性腺瘤。85例患者被选作术后结肠镜检查，其中32例至少重复检查一次，总共进行了60次重复检查。首次筛查时，19例患者（22%）发现腺瘤，但未发现癌症，但在重复结肠镜检查时，3例患者（9%）检测到早期异时性癌，21次检查（35%）发现腺瘤。仅1例接受临床检查的患者出现了有症状的肿瘤。这表明术后结肠镜检查对大多数患者不太可能有益，但对于有持续息肉形成且发生异时性癌风险高的年轻健康患者可能极为重要。
