Localizing colorectal cancer by colonoscopy.
OBJECTIVE
Colonoscopic localization of colorectal carcinoma is frequently inaccurate and unreliable.


METHODS
Consecutive case series.


METHODS
Tertiary care teaching hospital.


METHODS
Three hundred fourteen consecutive patients undergoing surgical resection for colorectal cancer from January 1, 2000, to December 31, 2003.


METHODS
Surgical resection for colorectal cancer.


METHODS
Incidence of erroneous site localization.


RESULTS
Two hundred thirty-six patients had complete endoscopic, pathologic, and operative records. Colonoscopy was inaccurate for tumor localization in 49 cases (21%). In 27 (11%) of these cases, a different procedure was required than initially planned; in an additional 10 cases (4%), the surgical approach required modification. Inaccurate localization was associated with previous colorectal procedures on both univariate analysis (odds ratio, 3.94; 95% confidence interval, 1.50-10.32; P<.005) and multivariate analysis (odds ratio, 4.47; 95% confidence interval, 1.64-12.08; P = .003). Having the colonoscopy performed by a surgeon trended toward protection from error on multivariate analysis (odds ratio, 0.47; 95% confidence interval, 0.20-1.08; P = .07). Age, sex, diverticular disease, endoscopist volume and years of training, and bowel preparation had no significant effect.


CONCLUSIONS
Colonoscopy has a considerable error rate for localization of colorectal cancer, especially when previous colorectal procedures have been performed. Adjunctive localizing techniques, such as endoscopic tattooing, should be strongly considered.
Piscatelli
Nicole
N
Department of Surgery, University of Vermont College of Medicine, 111 Colchester Avenue, Burlington, VT 05401, USA.
Hyman
Neil
N
Osler
Turner
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies