PREDICTIVE FACTORS AND SURGICAL IMPACT OF COLONOSCOPY ACCURACY IN LOCALIZATION OF COLORECTAL MALIGNANCY

Aims To evaluate the accuracy of colonoscopy in localization of colorectal malignancy, predictive factors of concordance with intra-operative localization and surgical sequelae of an incorrect localization.

Methods A retrospective analysis of all colonoscopies performed from January 2019 to December 2020 with identification of malignant lesions not adequate to endoscopic treatment and that undergone subsequent resection surgery was performed. Colonoscopy accuracy was evaluated in terms of correspondence between endoscopic and intra-operative tumor localization.

Results A total of 115 colonoscopies were evaluated, mostly correspondent to male patients (63.5%) with a mean age of 68.7 years. Bowel preparation adequateness was reported in 93 colonoscopies (80.9%), with an adequate grade in 76.4%. A complete colonoscopy was accomplished in 82.9% of cases. The most common tumor location at colonoscopy was sigmoid colon (27%), followed by ascending colon (14.8%). There was concordance between endoscopic and intra-operative localization in 76 cases, which corresponds to an accuracy of 66.1%. Colonoscopy completeness (p=0.008) and adequate bowel preparation (p=0.023) were significantly associated with greater concordance between endoscopic and intra-operative tumor location. There was no association with age, gender, tattooing or photographic documentation. Of the 39 incorrectly localized lesions, 19 (48.7%) required changes in surgical management.

Conclusions Colonoscopy revealed reasonable accuracy in localizing malignant lesions. An incorrect tumor localization at colonoscopy results in a high rate of changes in surgical management. Colonoscopy completeness and an adequate bowel preparation were significant predictors of accuracy in localizing colorectal malignancy, underscoring the importance of colonoscopy quality for this particular indication.

Publication History

Article published online:
14 April 2022