Colonoscopy, imaging, and carcinoembryonic antigen: Comparison of guideline adherence to surveillance strategies in patients who underwent resection of colorectal cancer - A systematic review and meta-analysis

Authors

Zaiba Shafik Dawood, Aga Khan UniversityFollow
Ahmad Hamad, The Ohio State University Wexner Medical Center, United States
Zorays Moazzam, The Ohio State University Wexner Medical Center, United States
Laura Alaimo, The Ohio State University Wexner Medical Center, United States
Henrique A. Lima, The Ohio State University Wexner Medical Center, United States
Chanza Shaikh, The Ohio State University Wexner Medical Center, United States
Muhammad Musaab Munir, The Ohio State University Wexner Medical Center, United States
Yutaka Endo, The Ohio State University Wexner Medical Center, United States
Timothy M. Pawlik, The Ohio State University Wexner Medical Center, United States

Document Type

Review Article

Department

Medical College Pakistan

Abstract

Introduction: Almost one-third of patients with colorectal cancer (CRC) experience recurrence after resection. Adherence to surveillance guidelines largely dictates efficacy in early detection of recurrence. We sought to assess and compare adherence to postoperative surveillance guidelines for colonoscopy, imaging, and Carcinoembryonic Antigen (CEA).
Methods: PubMed, Medline, Embase, Scopus, Cochrane, Web of Science, and CINAHL were systematically searched. Random-effects meta-analysis was performed and pooled adherence to each surveillance strategy was assessed for CEA, imaging, and colonoscopy.
Results: Overall 14 studies (55,895 patients) met the inclusion criteria. Adherence to colonoscopy guidelines was the highest (70%, 95%CI 67-73), followed by imaging (63%, 95%CI 47-80), and CEA (54%; 95%CI 42-66). Among 7 (50%) studies that examined adherence to the American Society of Clinical Oncology guidelines, compliance with colonoscopy was the highest (73%; 95% CI 70-76), followed by imaging (58%; 95% CI 37-78), and CEA (45%; 95%CI 37-52). Of note, guideline adherence to CEA testing was much lower than colonoscopy among patients with colon (OR 0.21; 95%CI 0.20-0.22) and rectal cancer (OR 0.25; 95%CI 0.23-0.28) (both p < 0.05). This was also noted when compared with imaging recommendations among older patients (OR = 0.62; 95%CI 0.42-0.93) and patients with stage II, (OR = 0.80; 95%CI 0.76-0.84) and stage III disease (OR = 0.88; 95%CI 0.82-0.94) (all p < 0.05).
Conclusion: While guideline adherence to postoperative surveillance with colonoscopy was high, adherence to CEA testing and imaging surveillance strategies was markedly lower following CRC resection. Future studies should investigate avenues to improve compliance with surveillance guidelines among health care providers and patients to optimize postoperative follow-up for CRC.

Comments

Issue No are not provided by the author/publisher

Publication (Name of Journal)

Surgical Oncology

Recommended Citation

Dawood, Z. S., Hamad, A., Moazzam, Z., Alaimo, L., Lima, H. A., Shaikh, C., Munir, M. M., Endo, Y., Pawlik, T. M. (2023). Colonoscopy, imaging, and carcinoembryonic antigen: Comparison of guideline adherence to surveillance strategies in patients who underwent resection of colorectal cancer - A systematic review and meta-analysis. Surgical Oncology, 47.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_mc/332