Spit, N.G. (2013) Onvolledige diagnostiek (colonoscopie) voor tweede primaire tumoren bij patiënten met een colorectaal carcinoom. Hoe groot is het probleem en wat kan er aan gedaan worden? thesis, Medicine.
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Abstract
Background: Patients with colorectal cancer (CRC) have a relatively high probability of the presence or metachronous development of a second primary tumor in the colon or rectum. Colonoscopy is the current gold standard in the diagnosis of colorectal carcinoma. In practice, there appears to be a significant part of patients which underwent no or an incomplete colonoscopy. Aim: Identifying patients with CRC in whom colonoscopy is not, or not completely, performed and to find out which are the underlying causes. Further, we investigated how many of these patients still had an additional colonoscopy post-surgery. The timing and results of these colonoscopies are collected. The outcomes of these additional colonoscopy were scored for incidence of second primary tumors and clinically relevant polyps. Methods: This study is an observational cohort study. The study population includes patients diagnosed with colorectal cancer whom underwent surgery between 2007 and 2010 (n=721) in the Medical Spectrum Twente Enschede. The statistical analysis is based on the survival of the groups with and without initial complete colonoscopy by means of Kaplan-Meier survival technique. In a multivariate analysis Cox regression was determined to analyse whether or not there was a difference in survival between the groups. The groups where corrected for the effects of differences in the distribution. Results: 50% of the patients (n=362) had no colonoscopy or an incomplete one prior to surgery. The main cause is an obstructive tumor (62%) followed by acute presentation (16%). 51% of the patients whom had an incomplete colonoscopy (n=185) still underwent colonoscopy up to the date of analysis. 10% of this group underwent no colonoscopy for unknown reasons. Of the 213 patients whom were indicated to undergo additional colonoscopy, 15 patients had a complete colonoscopy within 3 months (according to Dutch standards), 32 patients had a complete colonoscopy within 6 months (VS standard) and 89 patients within 1 year (old standard). That accounts for 7%, 15% and 41%, respectively. In 9 patients with an additional colonoscopy, a second neoplasia with treatment indication was detected. 3 of them underwent a second operation. Conclusion: Half of this cohort did not undergo a complete colonoscopy prior to surgery because of inability to pass the tumor or an acute presentation. The abnormalities missed during the initial staging, were detected in a later stage of the follow-up as a result of delay in the application of additional colonoscopies. Second primary neoplasia will either not be detected or detection will be delayed.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Bock, Prof. dr. de |
| Supervisor name: | Grossmann, Dr. and Klaase, Dr. and Kolkman, Prof. Dr. and Götz, Dr. and Medisch Spectrum Twente Enschede |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:44 |
| Last Modified: | 25 Jun 2020 10:44 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/524 |
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