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CA Cancer J Clin 2006; 56:160-167
doi: 10.3322/canjclin.56.3.160
© 2006 American Cancer Society
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 Guidelines for Colonoscopy Surveillance after Cancer Resection
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Guidelines for Colonoscopy Surveillance after Cancer Resection: A Consensus Update by the American Cancer Society and US Multi-Society Task Force on Colorectal Cancer*,{dagger}

Douglas K. Rex, MD, Charles J. Kahi, MD, MSc, Bernard Levin, MD, Robert A. Smith, PhD, John H. Bond, MD, Durado Brooks, MD, MPH, Randall W. Burt, MD, Tim Byers, MD, MPH, Robert H. Fletcher, MD, MSc, Neil Hyman, MD, David Johnson, MD, Lynne Kirk, MD, David A. Lieberman, MD, Theodore R. Levin, MD, Michael J. O’Brien, MD, MPH, Clifford Simmang, MD, Alan G. Thorson, MD and Sidney J. Winawer, MD


Dr. Rex is Chair, US Multi-Society Task Force on Colorectal Cancer; and Professor of Medicine, Indiana University School of Medicine, Indianapolis, IN.
Dr. Kahi is Assistant Professor of Medicine, Department of Medicine, Division of Gastroenterology and Hepatology, Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, IN.
Dr. B. Levin is Vice President, Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, TX.
Dr. Smith is Director, Cancer Screening, Cancer Control Science Department, American Cancer Society, Atlanta, GA.
Dr. Bond is Professor of Medicine, University of Minnesota; and Chief, Gastroenterology, Minneapolis VA Medical Center, Minneapolis, MN.
Dr. Brooks is Director, Prostate and Colorectal Cancer, Cancer Control Science Department, American Cancer Society, Atlanta, GA.
Dr. Burt is Interim Executive Director, Huntsman Cancer Institute and Professor of Medicine, University of Utah, Salt Lake City, UT.
Dr. Byers is Program Leader, Clinical Cancer Prevention and Control; and Professor, Department of Epidemiology, University of Colorado, Denver, CO.
Dr. Fletcher is Professor, Ambulatory Care and Prevention, Harvard Medical School, Boston, MA.
Dr. Hyman is Chief, General Surgery, University of Vermont, Burlington, VT.
Dr. Johnson is Professor of Medicine and Chief, Gastroenterology, Eastern Virginia School of Medicine, Norfolk, VA.
Dr. Kirk is Tim and Toni Hartman Professor, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
Dr. Lieberman is Chief, Division of Gastroenterology, Oregon Health and Science University, Portland, OR.
Dr. T. R. Levin is Associate Chief, Gastroenterology, Kaiser Permanente Medical Center, Walnut Creek, CA.
Dr. O’Brien is Professor, Medical Pathology, Boston University School of Medicine, Boston, MA.
Dr. Simmang is Associate Professor of Surgery, Department of Colon and Rectal Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
Dr. Thorson is Clinical Associate Professor of Surgery, Creighton School of Medicine and the University of Nebraska College of Medicine; Program Director, Section of Colon and Rectal Surgery, Creighton University, Omaha, NE.
Dr. Winawer is Paul Sherlock Chair in Medicine, Gastroenterology and Nutrition Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY.

Patients with resected colorectal cancer are at risk for recurrent cancer and metachronous neoplasms in the colon. This joint update of guidelines by the American Cancer Society (ACS) and US Multi-Society Task Force on Colorectal Cancer addresses only the use of endoscopy in the surveillance of these patients. Patients with endoscopically resected Stage I colorectal cancer, surgically resected Stage II and III cancers, and Stage IV cancer resected for cure (isolated hepatic or pulmonary metastasis) are candidates for endoscopic surveillance. The colorectum should be carefully cleared of synchronous neoplasia in the perioperative period. In nonobstructed colons, colonoscopy should be performed preoperatively. In obstructed colons, double contrast barium enema or computed tomography colonography should be done preoperatively, and colonoscopy should be performed 3 to 6 months after surgery. These steps complete the process of clearing synchronous disease. After clearing for synchronous disease, another colonoscopy should be performed in 1 year to look for metachronous lesions. This recommendation is based on reports of a high incidence of apparently metachronous second cancers in the first 2 years after resection. If the examination at 1 year is normal, then the interval before the next subsequent examination should be 3 years. If that colonoscopy is normal, then the interval before the next subsequent examination should be 5 years. Shorter intervals may be indicated by associated adenoma findings (see Postpolypectomy Surveillance Guideline). Shorter intervals are also indicated if the patient’s age, family history, or tumor testing indicate definite or probable hereditary nonpolyposis colorectal cancer. Patients undergoing low anterior resection of rectal cancer generally have higher rates of local cancer recurrence, compared with those with colon cancer. Although effectiveness is not proven, performance of endoscopic ultrasound or flexible sigmoidoscopy at 3- to 6-month intervals for the first 2 years after resection can be considered for the purpose of detecting a surgically curable recurrence of the original rectal cancer.




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