Abstract
Local recurrences after surgical treatment of gastrointestinal malignancies, especially rectal cancers, still represent a significant problem. True anastomotic recurrences are uncommon; most are extra-luminal and cannot be diagnosed by endoscopy. Endo-ultrasonography (EUS) provides high-resolution images of the GI wall and the adjacent organs, so it has been proposed for the postoperative follow-up of surgical anastomoses. EUS has proved to be highly sensitive in detecting local recurrences. Sometimes it can be difficult to distinguish an early recurrence from an anastomotic scar on the basis of EUS imaging alone. A tissue-specific diagnosis can then be achieved by performing an EUS-guided FNAB. However, for the anastomoses of the upper gastrointestinal tract, a follow-up program based on EUS has a very limited clinical impact because local tumor recurrences following surgical resection for esophageal cancer can rarely be treated by a reoperation. On the contrary, some patients with local recurrences after surgical resection of rectal cancers can undergo salvage surgery with a curative intent. Therefore, a periodic anastomotic evaluation by both proctoscopy and EUS could be justified, but no consensus exists on the modality and the duration of follow-up. Moreover, the cost-effectiveness and real survival advantage of the surveillance are still being debated.
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References
Lightdale CJ, Botet JF, Keksen DP, Turnbull AD, Brennan MF (1989) Diagnosis of recurrent upper gastrointestinal cancer at the surgical anastomosis by endoscopic ultrasound. Gastrointest Endosc 35:407–412
Hildebrandt U, Feifel G, Schwarz HP, Scherr O (1986) Endorectal ultrasound: instrumentation and clinical aspects. Int Colorect Dis 1:203–207
Beynon J, Mortensen NJ, Foy DMA, Channer JL, Rigby H, Virjee J (1989) Preoperative assessment of mesorectal lymph node involvement in rectal cancer. Br J Surg 76:276–279
Nakajima S (2001) The efficacy of the EUS for the detection of recurrent disease in the anastomosis of colon. Diagn Ther Endosc 7:149–158
Lindmark G, Elvin A, Pahlman L, Glimelius B (1992) The value of endosonography in preoperative staging of rectal cancer. Int J Colorectal Dis 7:162–166
Hizawa A, Aoyagi K, Suekane H, Mibu R, Yao T, Fujishima M (1996) Suture granuloma in rectal anastomosis mistaken for local recurrent cancer. J Clin Gastroenterol 23:78–79
Müller C, Kähler G, Scheele J (2000) Endosonographic examination of gastrointestinal anastomoses with suspected locoregional tumor recurrence. Surg Endosc 14:45–50
Rösch T, Classen M (1992) Colorectal carcinoma. In: Elder D (ed) Gastroenterologic endosonography. Thieme Medical, New York, pp 170–185
Hernandez de Anda E, Lee S, Finne CO, Rothenberger DA, Madoff RD, Garcia-Aguilar J (2004) Endorectal ultrasound in the follow-up of rectal cancer patients treated by local excision or radical surgery. Dis Colon Rectum 47:818–824
Hoffman JP, Riley L, Carp NZ, Litwin S (1993) Isolated locally recurrent rectal cancer: a review of incidence, presentation, and management. Semin Oncol 20:506–519
DeWitt J, Ghorai S, Kahi C, LeBlanc J, McHenry L, Chappo J, Cramer H, McGreevy K, Chriswell M, Sherman S (2003) EUS-FNA of recurrent postoperative extraluminal and metastatic malignancy. Gastrointest Endosc 58:542–548
Fockens P, Manshanden CG, van Lanschot JJ, Obertop H, Tytgat GNJ (1997) Prospective study on the value of endosonographic follow-up after surgery for esophageal carcinoma. Gastrointest Endosc 46:487–491
Abulafi AM, Williams NS (1994) Local recurrence of colorectal cancer: the problem, mechanisms, management and adjuvant therapy. Br J Surg 81:7–19
Qiurke P, Durdey P, Dixon MF, Williams NS (1986) Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet 2:996–999
Emslie J, Beart R, Mohiuddin M, Marks G (1998) Use of rectal cancer position as a prognostic indicator. Am Surg 64:958–961
Mellgren A, Sirivongs P, Rothenberger DA, Madoff RD, Garcia-Aguilar J (2000) Is local excision adequate therapy for early rectal cancer? Dis Colon Rectum 43:1064–1071
Romano G, Esercizio L, Santangelo M, Vallone G, Santangelo ML (1993) Impact of computer tomography vs. intrarectal ultrasound on the diagnosis, resectability, and prognosis of locally recurrent rectal cancer. Dis Colon Rectum 36:261–266
Hünerbein M, Totkas S, Moesta KT, Ulmer C, Handke T, Schlag PM (2001) The role of transrectal ultrasound-guided biopsy in the postoperative follow-up of patients with rectal cancer. Surgery 129:164–169
Löhnert MS, Doniec JM, Henne-Bruns D (2000) Effectiveness of endoluminal sonography in the identification of occult rectal cancer recurrences. Dis Colon Rectum 43:483–491
Wiersema MJ, Vilmann P, Giovannini M, Chang KJ, Wiersema IM (1997) Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment. Gastroenterology 112:1087–1095
Anthony T, Simmang C, Hyman N et al (2004) Parameters for the surveillance and follow up of patients with colon and rectal cancer. Dis Colon Rectum 47:807–817
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© 2014 Springer-Verlag Italia
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Napolitano, V., Bondanese, M.C., Avellino, M. (2014). Contribution of Endo-ultrasonography. In: Galloro, G. (eds) Endoscopic Follow-up of Digestive Anastomosis. Springer, Milano. https://doi.org/10.1007/978-88-470-5370-0_9
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DOI: https://doi.org/10.1007/978-88-470-5370-0_9
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