title: Colonoscopic surveillance after colorectal cancer resection: who needs more intensive follow-up?
abstract: OBJECTIVE
  Although there are guidelines for colonoscopic surveillance after colorectal cancer (CRC) surgery, the data evaluating the effectiveness of these guidelines are limited. We determined the risk factors for metachronous neoplasia (MN) by performing annual colonoscopy examinations after curative resection.
  
  
  METHODS
  We performed annual colonoscopic surveillance on stage I-III CRC patients after curative resection. We stratified the patients based on the advanced neoplasia risk during the surveillance.
  
  
  RESULTS
  Advanced MN detected was in 59 (13.1%) of 451 patients. Overall, the cumulative incidence of advanced MN was 17.3% at 5 years. By the multivariate analysis, the risk factors for advanced MN were male gender, age >65, left-sided index cancer and being in the high-risk group. The cumulative incidence of advanced MN was 38.9% at 5 years in the high-risk group. Among the patients who had advanced MN, secondary advanced MN was detected in 13 patients (22.0%) with a subsequent colonoscopy. The 2-year cumulative incidence of secondary advanced MN was 16.9%. Four (0.88%) patients had metachronous CRC during the surveillance and the interval from the index CRC was a median of 58.5 months.
  
  
  CONCLUSIONS
  Although the current follow-up guidelines for colonoscopic surveillance after CRC are well established, the high-risk group calls for more meticulous follow-up, which should be continued for a sufficient time.
authors: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors: Eun Kyung
authors: EK
authors: Choe
authors: Kyu Joo
authors: KJ
authors: Park
authors: Su Jin
authors: SJ
authors: Chung
authors: Sang Hui
authors: SH
authors: Moon
authors: Seung-Bum
authors: SB
authors: Ryoo
authors: Heung-Kwon
authors: HK
authors: Oh
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000453:epidemiology; D000367:Age Factors; D000368:Aged; D003082:Colectomy; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000175:diagnosis* / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods*; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors