Ann Surg Treat Res.  2024 Oct;107(4):212-220. 10.4174/astr.2024.107.4.212.

Optimal withdrawal time in initial surveillance colonoscopy after colorectal cancer surgery: comparison between anterior/low anterior resection and right hemicolectomy

• Bong JW
• Kim JY
• Ju Y
• Cheong C
• Kang S
• Lee SI
• Min BW

• KMID: 2560006
• DOI: http://doi.org/10.4174/astr.2024.107.4.212

Abstract

Purpose
This study aimed to investigate the optimal withdrawal time (WT) for initial surveillance colonoscopy after curative resection for colorectal cancer (CRC) by comparing anterior/low anterior resection (AR/LAR) and right hemicolectomy (RHC) groups.
Methods
This retrospective study analyzed 1,212 patients who underwent initial surveillance colonoscopy after CRC resection between 2015 and 2022. The patients were divided into the AR/LAR (n = 846) and RHC (n = 366) groups. The optimal WT was determined using receiver operating characteristic curve analysis and validated using logistic regression models. The adenoma and advanced neoplasia detection rates (ADR/ANDR) were evaluated based on the optimal WT.
Results
The optimal WT was 7 and 6 minutes in the AR/LAR and RHC groups, respectively. In multivariate analysis, WT ≥7 and ≥6 minutes in the AR/LAR (odds ratio [OR], 2.38; 95% confidence interval [CI], 1.75–3.24; P < 0.001) and RHC (OR, 2.64; 95% CI, 1.59–4.39; P = 0.001) groups, respectively, were significant factors for adenoma detection. In the AR/LAR group, ADR was 41.5% for WT ≥7 minutes compared to 21.9% for WT <7 minutes (P < 0.001). In the RHC group, ADR for WT ≥6 minutes was 33.9% compared to 15.8% for WT <6 minutes (P < 0.001). The ANDR also significantly improved with longer WTs in both groups.
Conclusion
This study suggests that a minimum WT of 7 and 6 minutes for AR/LAR and RHC patients, respectively, during the initial surveillance colonoscopy after CRC resection is optimal for maintaining a satisfactory ADR and ANDR. These findings highlight the importance of tailoring colonoscopic procedures according to the type of surgical resection.

Keyword

Colonoscopy; Colorectal neoplasms; Surgery; Surveillance

Figure

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  Fig. 1 Flowchart of patient selection.

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  Fig. 2 Receiver operating characteristic (ROC) curves of the optimal withdrawal time for adenoma detection in different surgical treatment groups. (A) Anterior/low anterior resection (AR/LAR). (B) Right hemicolectomy (RHC). AUC, area under the ROC curve.

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  Fig. 3 Restricted cubic spline regression analysis for adenoma detection rate and withdrawal time of different surgical treatment groups. (A) Anterior/low anterior resection. Adjusted to age of <75 years and male sex. (B) Right hemicolectomy. Adjusted to age of <75 years. CI, confidence interval.

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