SNFGE SNFGE
 
Thématique :
- Cancer colorectal (CCR)
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Docteur Roger FAROUX
Coup de coeur :
 
 
Gastroenterology
  2019/04  
 
  2019 Apr;156(5):1309-1323.e3.  
  doi: 10.1053/j.gastro.2018.12.006.  
 
  New and Recurrent Colorectal Cancers After Resection: a Systematic Review and Meta-analysis of Endoscopic Surveillance Studies.  
 
  Fuccio L, Rex D, Ponchon T, Frazzoni L, Dinis-Ribeiro M, Bhandari P, Dekker E, Pellisè M, Correale L, van Hooft J, Jover R, Libanio D, Radaelli F, Alfieri S, Bazzoli F, Senore C, Regula J, Seufferlein T, Rösch T, Sharma P, Repici A, Hassan C  
  https://www.ncbi.nlm.nih.gov/pubmed/30553914  
 
 

Abstract

BACKGROUND & AIMS:

Outcomes of endoscopic surveillance after surgery for colorectal cancer (CRC) vary with the incidence and timing of CRC detection at anastomoses or non-anastomoses in the colorectum. We performed a systematic review and meta-analysis to evaluate the incidence of CRCs identified during surveillance colonoscopies of patients who have already undergone surgery for this cancer.

METHODS:

We searched PubMed, EMBASE, SCOPUS, and the Cochrane Central Register of Clinical Trials through January 1, 2018 to identify studies investigating rates of CRCs at anastomoses or other locations in the colorectum after curative surgery for primary CRC. We collected data from published randomized controlled, prospective, and retrospective cohort studies. Data were analyzed by multivariate meta-analytic models.

RESULTS:

From 2373 citations, we selected 27 studies with data on 15,803 index CRCs for analysis (89% of patients with stage I-III CRC). Overall, 296 CRCs at non-anastomotic locations were reported over time periods of more than 16 years (cumulative incidence, 2.2% of CRCs; 95% confidence interval [CI], 1.8%-2.9%). The risk of CRC at a non-anastomotic location was significantly reduced more than 36 months after resection compared with before this time point (odds ratio for non-anastomotic CRCs at 36-48 months vs 6-12 months aftersurgery, 0.61; 95% CI, 0.37-0.98; P = .031); 53.7% of all non-anastomotic CRCs were detected within 36 months of surgery. One hundred and fifty-eight CRCs were detected at anastomoses (cumulative incidence of 2.7%; 95% CI, 1.9%-3.9%). The risk of CRCs at anastomoses was significantly lower 24 months after resection than before (odds ratio for CRCs at anastomoses at 25-36 months after surgery vs 6-12 months, 0.56; 95% CI, 0.32-0.98; P = .036); 90.8% of all CRCs at anastomoses were detected within 36 months of surgery.

CONCLUSIONS:

After surgery for CRC, the highest risk of CRCs at anastomoses and at other locations in the colorectum is highest during 36 months after surgery-risk decreases thereafter. Patients who have undergone CRC resection should be evaluated by colonoscopy more closely during this time period. Longer intervals may be considered thereafter.

 

 
Question posée
 
Après exérèse d’un cancer colorectal, comment évolue dans le temps le risque de récidive anastomotique et non anastomotique ?
 
Question posée
 
Il est maximum dans les 24 mois suivant la chirurgie pour les récidives anastomotiques et dans les 36 mois pour les récidives non anastomotiques.
 
Commentaires

Cette méta analyse va dans le sens des recommandations Américaines de surveillance endoscopique après chirurgie curative des cancers colorectaux (1) avec coloscopie à 1 an, 3 ans puis plus espacées ensuite.

Le TNCD propose une première coloscopie à 3 ans mais insiste sur la qualité de la coloscopie préopératoire. Si celle-ci est incomplète ou de mauvaise qualité la 1ère coloscopie de surveillance est à faire dans les 9 mois post-opératoire (2).

(1)Kahi CJ, Boland CR, Dominitz JA, et al. Colonoscopy surveillance after colorectal cancer resection: recommendations of the US multi-society task force on colorectal cancer. Gastrointest Endosc 2016;83:489-98.e10.

(2) Lecomte T, André T, Bibeau F, Blanc B, Cohen R, Lagasse JP, Laurent-Puig P, Martin-Babau J, Panis Y, Portales F, Taïeb J, Vaillant E. « Cancer du côlon non métastatique » Thésaurus National de Cancérologie Digestive, Janvier 2019, [En ligne] [https://www.snfge.org/tncd et http://www.tncd.org ]

 

 
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