Do Patients With Young-Onset Colorectal Cancer Require More Frequent Surveillance Colonoscopy?
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Do Patients With Young-Onset Colorectal Cancer Require More Frequent Surveillance Colonoscopy?

Douglas K. Rex, MD, MASGE, reviewing Peacock O, et al. Gastroenterology 2022 Aug 17.

Current recommendations for sporadic colorectal cancer (CRC) are to perform surveillance colonoscopy 1 year after surgical resection, then at 3 years, and then at 5-year intervals.

In a single-center U.S. report, investigators followed 457 patients with young-onset colorectal cancer (YOCRC; defined as CRC diagnosed at ≤50 years) who had endoscopy records and had neither recurrent disease nor hereditary CRC. The original cancer was located in the proximal colon in 9.4% of patients, distal colon in 23%, and rectum in 67.6%. Follow-up colonoscopy demonstrated 6 lumenal recurrences and 32 “metachronous” lesions, of which 31 were high-risk adenomas (advanced adenomas or ≥3 adenomas) and 1 was described as CRC but was actually intramucosal carcinoma (better-called high-grade dysplasia). Twenty-four (63%) events occurred within 15 months of resection, and another 9 (23.7%) occurred within the 48-month time point.

Douglas K. Rex, MD, FASGE

COMMENT

Metachronous-appearing lesions after CRC resection are likely often missed synchronous lesions, which accounts for the high yield of apparently metachronous lesions at the 1-year follow-up colonoscopy. However, this study found no metachronous lesions with submucosal invasion. Therefore, this study does not support changing recommended intervals for surveillance colonoscopy in patients with YOCRC compared to older patients with CRC. Identifying recurrences of the original primary cancer is a separate issue from surveillance colonoscopy, as colonoscopy is seldom the best method to detect early recurrence of the original cancer.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Peacock O, Vilar E, Trueba MG, Thirumurthi S, Chang GJ, You YN. Clinically significant metachronous colorectal pathology detected among young-onset colorectal cancer survivors: implications for post-resection surveillance guidelines. Gastroenterology 2022 Aug 17. (Epub ahead of print) (https://doi.org/10.1053/j.gastro.2022.08.030)

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