Current Australian NHMRC guidelines (2011) recommend first surveillance colonoscopy at 12 months after curative resection of colorectal cancer, and subsequent colonoscopies at three to five year intervals1. There may be several barriers to this within the Australian public health system. We sought to assess current practices in colonoscopic surveillance within our institution, including compliance to guidelines, reasons for delay, and rates of local recurrence/new primary.
Eastern Health patients undergoing curative resection of stage 1-3 colorectal cancer between 1 July 2014 and 30 June 2015 were identified using hospital coding data. Demographic and clinical data were reviewed from hospital records. Surveillance colonoscopy performed within 18 months was deemed “acceptable” to allow for anticipated delays due to waitlists.
124 patients were identified; 75 (60%) had post-operative colonoscopy data available from hospital records. Of these patients, 61/75 (81%) had colonoscopy within 18 months and 32 (43%) within 12 months of surgery. Median time to first post-operative colonoscopy was 14 months (2-26 months). Median waitlist time was two months.
31/124 (25%) patients did not undergo post-operative colonoscopy. The most common reasons for this were: not clinically indicated e.g. deceased or relapsed (39%), lost to follow-up (19%), and medically unfit (13%). There was insufficient data for 18 (15%) patients who had external follow-up post-operatively.
At time of analysis and with a median follow-up of 22 months, one local recurrence and no new primary colorectal cancers have been detected on surveillance colonoscopy.
A significant proportion of patients did not have a documented surveillance colonoscopy within our pre-determined acceptable timeframe of 18 months. Median waitlist time was short, suggesting other barriers to timelines of colonoscopy. Ongoing longitudinal analysis, collection of data from primary providers (LMOs) and a survey of endoscopists may help to identify barriers and variations in practice.