Mo1683 QUALITY OF PREOPERATIVE COLONOSCOPY IN PATIENTS UNDERGOING SURGERY FOR COLORECTAL CANCER

Abstract

Colonoscopy provides important information that impacts the outcomes of subsequent surgical interventions for colorectal cancer. This includes description of the tumor, anatomical location, size and presence of synchronous polyps/tumors. Marking of lesions with tattoo can assist surgical localization and decrease surgical errors. In this study we aimed to evaluate the documentation and performance preoperative colonoscopy in patients with lesions suspicious for colorectal cancer. We conducted a retrospective chart audit of 198 patients who underwent colonoscopy prior to colectomy for colorectal cancer at our institution between January 2013 and January 2018. Data reviewed included the indication for the procedure, duration, completion of procedure (if not at index procedure, within 6m after surgery), quality of bowel preparation, tumor location and size, performance of endoscopic tattooing, subsequent surgical interventions and pathology reports. Findings: Consistently documented variables included the procedure date, indication for the procedure, extent reached and type of sedation (100%). Tumor size was documented in 43% of cases. The distribution of lesions in the colon was the following: cecum 18%, ascending colon 19%, transverse colon 8%, descending colon 3%, sigmoid colon 29% and rectum 23%. Complete examination of the colon was performed in 80% of the cases. In patients who did not undergo complete examination perioperatively, (15/40) 35% had a repeat colonoscopy and (25/40) 65% of patients with incomplete examination did not undergo repeat testing due to progressive disease, death and loss to follow up. Endoscopic tattooing was performed in (57/117) 29% of the cases with lesions in non-fixed location (excluding rectum and cecum) and localization measuring the distance from the anal canal was performed in 48% of the cases. The endoscopic estimation of tumor size did not correlate with pathologic specimen. We found significant room for improvement in the quality of endoscopic reporting and performance in patients with colorectal cancer. The data will provide feedback to physicians on performance and help implementing systemic quality improvement interventions.Endoscopic estimation of size compared to pathologic measurementView Large Image Figure ViewerDownload Hi-res image Download (PPT)