FTP2.2 Retrospective analysis of potentially missed right-sided colon cancer

Abstract

Abstract Background Right colon cancer can be missed due to either inadequate assessment or suboptimal investigations. This audit evaluated a present clinical practice and highlighted points to improve the diagnostic ability of clinicians. Methods Records of patients diagnosed with right colon malignancy between 2015 till 2020 were screened for missed diagnostic opportunities in the 3 years preceding their cancer diagnosis. Reasons were categorised as: a critical miss (includes inadequate investigations of a significant encounter with suggestive symptoms or lost follow up) and a potential miss (encounters with less suggestive symptoms or insufficient investigations). Results While 116 patients (49%), out of the included 235 patients, had at least 1 previous encounter with suggestive symptoms, only 83 (71.5%) of them were investigated. 56 patients had a previous colorectal investigation, with CT imaging being the most frequent test requested, and performed for approximately half of the patients. 30 (13%) incidents of critical diagnostic miss, and 28 (12%) incidents of potential diagnostic miss were identified. (Table 1) Conclusions Clinicians should adequately investigate suggestive symptoms of right colon cancer, including patients older than 40 with appendicitis. Our results conform with the reported less than optimal sensitivity (75-100%) of non-targeted CT to pick up early colonic cancer, and with the probable false sense of reassurance after unremarkable flexible sigmoidoscopy for potential symptoms of right colon cancer.