Edwards GC, et al. J Am Coll Surg 2020.
BACKGROUND: While endoscopy is recommended at one year after colorectal cancer (CRC) resection to detect locally recurrent CRC, prior work at our Veterans Affairs (VA) facility demonstrated that 35% of patients achieve this metric.
STUDY DESIGN: The interdisciplinary team used quality improvement methods to standardize processes and implement a gastroenterology-managed virtual surveillance clinic. The intervention clinic was implemented in August 2014. Veterans who underwent resection for stage I-III CRC at a single VA facility from January 2010 - December 2017 were included, with those undergoing resection between January 2010 - July 2014 considered pre-intervention and those undergoing resection between August 2014 - December 2017 considered post-intervention. The primary outcome was the proportion of eligible patients for whom endoscopy was completed within 1 year of resection. Secondary outcomes were the proportion who completed endoscopy within 18 months of resection or at any time post-resection, and time to surveillance endoscopy.
RESULTS: A total of 186 patients underwent resection for stage I-III CRC from 2010-2017; of these 160 (86%) were eligible for endoscopy at 1-year post-resection (98 pre-intervention and 62 post-intervention). In the pre-intervention period, 30/98 (30.6%) underwent surveillance endoscopy within one year versus 31/62 (50.0%) post-intervention (P=0.031). When evaluated at 18 months after resection, 56/98 (57.1%) in the pre-intervention group versus 52/62 (83.9%) in the post-intervention group underwent surveillance endoscopy (P=0.001). Median time from resection to endoscopy decreased over the study period, from 1.19 years pre-intervention (Interquartile range [IQR] 0.93, 1.74) to 1.0 years post-intervention (IQR 0.93, 1.09) (P=0.006).
CONCLUSIONS: Implementation of a virtual surveillance clinic with standardized processes was associated with increased guideline-concordant endoscopic surveillance after CRC resection.