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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

Objective:
The objective of this study was to define the accuracy of colonoscopy in identifying the location of colorectal cancer.
Design:
Consecutive case series.
Setting:
Tertiary care teaching hospital.
Patients:
Three hundred fourteen consecutive patients undergoing surgical resection for colorectal cancer from January 1, 2000 - December 31, 2003.
Intervention:
Surgical resection for colorectal cancer.
Main Outcome Measures:
Incidence of erroneous site localization.
Results:
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.
Conclusions:
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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