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Localizing Colorectal Cancer by Colonoscopy: Are We Missing the Boat?

Nicole Piscatelli, Neil Hyman, Turner Osler
University of Vermont, Burlington, VT

The objective of this study was to define the accuracy of colonoscopy in identifying the location of colorectal cancer.
Consecutive case series.
Tertiary care teaching hospital.
Three hundred fourteen consecutive patients undergoing surgical resection for colorectal cancer from January 1, 2000 - December 31, 2003.
Surgical resection for colorectal cancer.
Main Outcome Measures:
Incidence of erroneous site localization.
Two hundred thirty-six patients had complete endoscopy, pathology and surgical records. Colonoscopy was inaccurate for tumor localization in 49 cases (21%). In 27 of these cases (11%), a different operation was required than initially planned; in an additional 10 cases (4%), the surgical approach required modification. Inaccurate localization was associated with previous colorectal surgery on both univariate analysis (OR 3.9, 95%; 1.50-10.31, p<.005) and multivariate analysis (OR 4.47, 95%, CI 1.64-12.08 p=0.003). Having the colonoscopy performed by a surgeon trended towards protection from error on multivariate analysis (OR 0.47, 95% CI 0.20-1.08, p=0.07). Age, gender, diverticular disease, endoscopist volume and years of training, and bowel preparation had no significant effect.
Colonoscopy has a significant error rate for localization of colorectal cancer, especially when previous colorectal surgery has been performed. Adjunctive localizing techniques, such as endoscopic tattooing should be strongly considered.

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