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van Lanschot MCJ, van Leerdam ME, Lansdorp-Vogelaar I, Doets S, Nagtegaal ID, Schreurs HW, van der Hulst RWM, Carvalho B, Dekker E, van Berkel AM. Yield of Surveillance Colonoscopies 1 Year After Curative Surgical Colorectal Cancer Resections. Clin Gastroenterol Hepatol 2019; 17:2285-2293. [PMID: 30802606 DOI: 10.1016/j.cgh.2019.02.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 02/11/2019] [Accepted: 02/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Endoscopic surveillance after curative colorectal cancer (CRC) resection is routine. However, there is controversy whether the 1-year interval between preoperative and postoperative colonoscopy is justified owing to improved colonoscopy standards. We aimed to assess the yield of surveillance colonoscopies 1 year after CRC surgery. METHODS We performed a retrospective cohort study of 572 patients (54.9% male; mean age, 66.2 ± 9.9 y), who underwent curative surgical resection of a first CRC from June 2013 through April 2016 in the Northwest region of The Netherlands. Patients were included if a complete clearing colonoscopy was performed before surgery and the interval between the preoperative and postoperative colonoscopy was 12 months (range, 6-20 mo), conforming to Dutch guidelines. The primary outcome of the study was the yield of CRC at the surveillance colonoscopy performed 1 year after curative resection. A secondary outcome was the yield of advanced neoplasia. RESULTS After a mean surveillance interval of 13.7 months (±2.8 mo), 10 of 572 patients (1.7%; 95% CI, 0.7%-2.8%) received a diagnosis of CRC. Of these, 5 CRCs were apparently metachronous cancers (3 were stage III or IV) and 5 were recurrences at the anastomosis (1 was stage IV). In 11.4% of patients (95% CI, 8.9%-13.8%), advanced neoplasia was detected at the 1-year follow-up colonoscopy. Synchronous advanced neoplasia at baseline colonoscopy was a risk factor for detection of advanced neoplasia at the follow-up colonoscopy (odds ratio, 2.2; 95% CI, 1.3-3.8; P ≤ .01). CONCLUSIONS Despite high colonoscopy quality, the yield of CRC at surveillance colonoscopy 1 year after CRC resection was 1.7%. These were metachronous CRCs and recurrences, often of advanced stage. The high yield justifies the recommendation of a 1-year surveillance interval after surgical CRC resection.
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Affiliation(s)
- Meta C J van Lanschot
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Gastroenterology and Hepatology, Cancer Centre Amsterdam, Amsterdam University Medical Centre, University of Amsterdam, The Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus Medical Centre, University Medical Centre Rotterdam, The Netherlands
| | - Sharon Doets
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Hermien W Schreurs
- Department of Surgery, Noord West Ziekenhuisgroep, Alkmaar, The Netherlands
| | | | - Beatriz Carvalho
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Cancer Centre Amsterdam, Amsterdam University Medical Centre, University of Amsterdam, The Netherlands
| | - Anne-Marie van Berkel
- Department of Gastroenterology, NoordWest Ziekenhuisgroep, Alkmaar, The Netherlands.
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Bousema JE, Dijkgraaf MGW, Papen-Botterhuis NE, Schreurs HW, Maessen JG, van der Heijden EH, Steup WH, Braun J, Noyez VJJM, Hoeijmakers F, Beck N, van Dorp M, Claessens NJM, Hiddinga BI, Daniels JMA, Heineman DJ, Zandbergen HR, Verhagen AFTM, van Schil PE, Annema JT, van den Broek FJC. MEDIASTinal staging of non-small cell lung cancer by endobronchial and endoscopic ultrasonography with or without additional surgical mediastinoscopy (MEDIASTrial): study protocol of a multicenter randomised controlled trial. BMC Surg 2018; 18:27. [PMID: 29776444 PMCID: PMC5960166 DOI: 10.1186/s12893-018-0359-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 05/02/2018] [Indexed: 12/24/2022] Open
Abstract
Background In case of suspicious lymph nodes on computed tomography (CT) or fluorodeoxyglucose positron emission tomography (FDG-PET), advanced tumour size or central tumour location in patients with suspected non-small cell lung cancer (NSCLC), Dutch and European guidelines recommend mediastinal staging by endosonography (endobronchial ultrasound (EBUS) and endoscopic ultrasound (EUS)) with sampling of mediastinal lymph nodes. If biopsy results from endosonography turn out negative, additional surgical staging of the mediastinum by mediastinoscopy is advised to prevent unnecessary lung resection due to false negative endosonography findings. We hypothesize that omitting mediastinoscopy after negative endosonography in mediastinal staging of NSCLC does not result in an unacceptable percentage of unforeseen N2 disease at surgical resection. In addition, omitting mediastinoscopy comprises no extra waiting time until definite surgery, omits one extra general anaesthesia and hospital admission, and may be associated with lower morbidity and comparable survival. Therefore, this strategy may reduce health care costs and increase quality of life. The aim of this study is to compare the cost-effectiveness and cost-utility of mediastinal staging strategies including and excluding mediastinoscopy. Methods/design This study is a multicenter parallel randomized non-inferiority trial comparing two diagnostic strategies (with or without mediastinoscopy) for mediastinal staging in 360 patients with suspected resectable NSCLC. Patients are eligible for inclusion when they underwent systematic endosonography to evaluate mediastinal lymph nodes including tissue sampling with negative endosonography results. Patients will not be eligible for inclusion when PET/CT demonstrates ‘bulky N2-N3’ disease or the combination of a highly suspicious as well as irresectable mediastinal lymph node. Primary outcome measure for non-inferiority is the proportion of patients with unforeseen N2 disease at surgery. Secondary outcome measures are hospitalization, morbidity, overall 2-year survival, quality of life, cost-effectiveness and cost-utility. Patients will be followed up 2 years after start of treatment. Discussion Results of the MEDIASTrial will have immediate impact on national and international guidelines, which are accessible to public, possibly reducing mediastinoscopy as a commonly performed invasive procedure for NSCLC staging and diminishing variation in clinical practice. Trial registration The trial is registered at the Netherlands Trial Register on July 6th, 2017 (NTR 6528). Electronic supplementary material The online version of this article (10.1186/s12893-018-0359-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jelle E Bousema
- Department of Surgery, Máxima Medical Center, PO BOX 7777, 5500 MB, Veldhoven, the Netherlands.,University of Amsterdam, Amsterdam, the Netherlands
| | - Marcel G W Dijkgraaf
- University of Amsterdam, Amsterdam, the Netherlands.,Clinical Research Unit, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Hermien W Schreurs
- Department of Surgery, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Erik H van der Heijden
- Department of Pulmonary Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Willem H Steup
- Department of Surgery, HagaZiekenhuis, Den Haag, the Netherlands
| | - Jerry Braun
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Fieke Hoeijmakers
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Dutch Institute for Clinical Auditing, Leiden, the Netherlands
| | - Naomi Beck
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Dutch Institute for Clinical Auditing, Leiden, the Netherlands
| | - Martijn van Dorp
- Department of Surgery, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | - Niels J M Claessens
- Department of Pulmonary Medicine, Rijnstate ziekenhuis, Arnhem, the Netherlands
| | - Birgitta I Hiddinga
- Department of Pulmonary Medicine, University of Groningen and University Medical Centre Groningen, Groningen, the Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - David J Heineman
- Department of Surgery, VU University Medical Center, Amsterdam, the Netherlands.,Department of Cardiothoracic Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Harmen R Zandbergen
- Department of Cardiothoracic Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Ad F T M Verhagen
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Paul E van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Jouke T Annema
- University of Amsterdam, Amsterdam, the Netherlands.,Department of Pulmonary Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Frank J C van den Broek
- Department of Surgery, Máxima Medical Center, PO BOX 7777, 5500 MB, Veldhoven, the Netherlands.
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