EP143 - From Recommendation to Reality: Endoscopic Surveillance Guidelines and Onset of Colorectal Cancer

ePoster Presenter(s)

• 

  Benjamin Gallant, MD

  General Surgery Resident
  UMass Chan Medical School
  UMass Chan Medical School
  Worcester, MA, United States

  Disclosure information not submitted.

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Author(s)

• 

  Andrew Hu, MD

  General Surgery Resident
  UMass Chan Medical School
  University of Massachusetts T.H Chan Medical School
  Worcester, MA, United States

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
• HH

  HyukJoo Hwang

  Medical Student
  University of Massachusetts Chan Medical School
  University of Massachusetts Chan Medical School
  Worcester, MA, United States

  Disclosure information not submitted.
• 

  Kaitlyn Oldewurtel, D.O. (she/her/hers)

  Fellow
  UT Southwestern
  UT Southwestern
  Dallas, TX, United States

  Disclosure information not submitted.
• ZN

  Zoe Nepomnayshy, n/a

  Medical Student
  UMass T.H. Chan School of Medicine
  Somerville, Massachusetts, United States

  Disclosure information not submitted.
• TP

  Thomas Peponis, MD, FACS

  Colon and Rectal Surgeon, Assistant Professor of Surgery
  University of Massachusetts
  Worcester, Massachusetts, United States

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
• 

  Tess H. Aulet, MD (she/her/hers)

  Colorectal Surgeon
  UMass Memorial Medical Center
  UMass Memorial Medical Center
  Worcester, Massachusetts, United States

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no relevant financial relationships.
• PS

  Paul R. Sturrock, MD

  Assistant Professor of Surgery
  UMassMemorial Medical Center
  Worcester, Massachusetts, United States

  Disclosure information not submitted.
• 

  Karim Alavi, MD, MPH

  Associate Professor of Surgery, Director, Colon and Rectal Surgery Fellowship
  UMass Chan Medical School
  southborough, Massachusetts, United States

  Disclosure information not submitted.

Senior Author(s)

• 

  Justin Maykel, MD

  Chief, Division of Colorectal Surgery
  UMass Memorial Health
  UMass Chan Medical School
  Worcester, MA, United States

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no relevant financial relationships.

Purpose/Background: Colorectal cancer is the third leading cause of cancer-related mortality among both males and females in the U.S. Currently, well-established guidelines exist for endoscopic surveillance, specifically for the prevention and early detection of colorectal cancer. Our study aims to assess the adherence to and efficacy of recommended surveillance intervals for patients who developed colorectal cancer.

Methods/Interventions: We performed a retrospective chart review of all consecutive patients who previously had undergone colorectal cancer screening and were subsequently diagnosed with colon or rectal cancer for which they underwent resection at a tertiary academic medical center between October 2017 and October 2024. We excluded patients with hereditary cancer syndromes, IBD, or those with missing surveillance data. We determined the interval follow-up recommendations from the prior colonoscopy or non-invasive screening test and tracked compliance. Non-adherent patients were defined as those who presented beyond their recommended surveillance interval. The primary outcome was adherence to recommended surveillance intervals at the time of colorectal cancer diagnosis. Secondary outcomes included the interval between prior screening and diagnosis, operative details, and pathologic stage at presentation.

Results/Outcomes: Chart review identified 147 patients. Patients had a mean age of 72 at the time of diagnosis, 56% were women, and 91% were white. Surveillance colonoscopy interval was recommended at 5 years (36%), 10 years (22%), 3 years (20%), 1 year (13%), and within 1 year (8%). Only 22% of all patients adhered to their recommended surveillance timeline. Among those who did not adhere, 37% presented earlier than recommended by a median of 2 years (IQR 1-3). Non-adherent patients who presented after their recommended timeline did so by a median of 2.5 years (IQR 1-5.8). Non-adherent patients who presented beyond their recommended timeline had a significantly longer median time to diagnostic endoscopy compared to those who were adherent (93 vs 58 months, p-value < 0.001). The most common location of cancer was the ascending colon, and the most common procedure performed was a right hemicolectomy (55%). Overall, 33% of patients had pathologic stage III disease and 6% had stage IV disease. There was no difference in overall pathologic stage between adherent and non-adherent patients (p = 0.152).

Conclusion/Discussion: Our findings demonstrate that despite following established surveillance guidelines, a significant number of patients still develop colorectal cancer. In addition, a small percentage of patients adhere to the surveillance recommendations. Together, these findings highlight the need to re-evaluate existing surveillance protocols and develop targeted strategies to improve patient adherence.

Figure 1. Scatter Plot of Actual Surveillance Follow-Ups by Recommended Intervals
Table 1. Overview of Treatment Course and Pathologic Outcomes