Is Colonoscopy Alone Adequate for Surveillance in Stage I Colorectal Cancer?

• Published in: Cancer research and treatment Vol. 57; no. 2; pp. 507 - 518
• Main Authors: Kim, Seijong, Shin, Jung Kyong, Park, Yoonah, Huh, Jung Wook, Kim, Hee Cheol, Yun, Seong Hyeon, Lee, Woo Yong, Cho, Yong Beom
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Cancer Association 01.04.2025; 대한암학회
• Subjects: Adult; Aged; Aged, 80 and over; Colonoscopy - methods; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - diagnostic imaging; Colorectal Neoplasms - pathology; Colorectal Neoplasms - surgery; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local - diagnosis; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Original; Retrospective Studies; Risk Factors; 의학일반; Recurrence; Stage I; Colorectal neoplasms; Surveillance
• ISSN: 1598-2998; 2005-9256; 2005-9256
• DOI: 10.4143/crt.2024.526

Purpose While colonoscopy is the standard surveillance tool for stage I colorectal cancer according to National Comprehensive Cancer Network guidelines, its effectiveness in detecting recurrence is debated. This study evaluates recurrence risk factors and patterns in stage I colorectal cancer to inform comprehensive surveillance strategies.Materials and Methods A retrospective analysis of 2,248 stage I colorectal cancer patients who underwent radical surgery at Samsung Medical Center (2007-2018) was conducted. Exclusions were based on familial history, prior recurrences, preoperative treatments, and inadequate data. Surveillance included colonoscopy, laboratory tests, and computed tomography (CT) scans.Results Stage I colorectal cancer patients showed favorable 5-year disease-free survival (98.3% colon, 94.6% rectum). Among a total of 1,467 colon cancer patients, 26 (1.76%) experienced recurrence. Of the 781 rectal cancer patients, 47 (6.02%) experienced recurrence. Elevated preoperative carcinoembryonic antigen levels and perineural invasion were significant recurrence risk factors in colon cancer, while tumor budding was significant in rectal cancer. Distant metastasis was the main recurrence pattern in colon cancer (92.3%), while rectal cancer showed predominantly local recurrence (50%). Colonoscopy alone detected recurrences in a small fraction of cases (3.7% in colon, 14.9% in rectum).Conclusion Although recurrence in stage I colorectal cancer is rare, relying solely on colonoscopy for surveillance may miss distant metastases or locoregional recurrence outside the colorectum. For high-risk patients, we recommend considering regular CT scans alongside colonoscopy. This targeted approach may enable earlier recurrence detection and improve outcomes in this subset while avoiding unnecessary scans for the low-risk majority.