Korean J Gastroenterol.  2017 Jul;70(1):33-38. 10.4166/kjg.2017.70.1.33.

Local Recurrence and Its Risk Factor after Incomplete Resection of Colorectal Advanced Adenomas: A Single Center, Retrospective Study

• Oh DM
• Lee JK
• Kim H
• Park CK
• Jung JK
• Kim DJ
• Chung YJ
• Kim TH
• Park MI
• Park JP

• KMID: 2390782
• DOI: http://doi.org/10.4166/kjg.2017.70.1.33

Abstract

BACKGROUND/AIMS
Colonoscopy can detect precancerous lesions, which can subsequently be removed and reduce incidences of and mortality from colorectal cancer (CRC). However, recently published data have highlighted a significant rate of CRC in patients who previously underwent colonoscopy. Among many reasons, incomplete resection has been considered as a significant contributor. However, to date, there have only been a few studies regarding incompletely resected polyps, especially advanced colorectal adenoma (ACA). Hence, we aimed to evaluate the prognosis of incompletely resected ACA.
METHODS
We retrospectively reviewed the medical records of patients with ACA who had underwent endoscopic treatment with incomplete resection. The primary outcomes were (1) the incomplete resection rate of ACA, as determined by a histopathologic examination and (2) the recurrence rate of incompletely resected ACA. We also investigated the probable contributing factors that may have led to a relapse of incompletely resected ACA.
RESULTS
A total of 7,105 patients had their colorectal polyps resected by endoscopic treatment, and 2,233 of these were considered as ACA. Of these, 354 polyps (15.8%) were resected incompletely, and only 163 patients were followed-up. Of those followed-up, 31 patients (19.0%) experienced local recurrence. The risk factors for recurrence after incomplete resection were evaluated; age, morphology of adenoma, and use of rescue therapy, such as argon plasma coagulation, were found to be associated with adenoma recurrence.
CONCLUSIONS
Incompletely resected ACA in older patients or in patients with sessile-type adenomas should be monitored strictly, and if incomplete resection is suspected, rescue therapy must be considered.

Keyword

Colonoscopy; Adenoma; Colorectal neoplasms; Colonic polyps; Local neoplasm recurrence Received

MeSH Terms

Adenoma*
Argon Plasma Coagulation
Colonic Polyps
Colonoscopy
Colorectal Neoplasms
Humans
Incidence
Medical Records
Mortality
Polyps
Prognosis
Recurrence*
Retrospective Studies*
Risk Factors*

Figure

• 

  Fig. 1. Flow diagram for the study. EMR, endoscopic mucosal resection; ESD, endoscopic submucosal dissection.

Reference

References

1. Ferlay J, Parkin DM, Steliarova-Foucher E. Estimates of cancer incidence and mortality in Europe in 2008. Eur J Cancer. 2010; 46:765–781.

2. Soerjomataram I, Lortet-Tieulent J, Parkin DM, et al. Global burden of cancer in 2008: a systematic analysis of disability-adjusted life-years in 12 world regions. Lancet. 2012; 380:1840–1850.

3. Winawer SJ. Natural history of colorectal cancer. Am J Med. 1999; 106(1A):3S–6S. discussion 50S–51S.

4. Leung K, Pinsky P, Laiyemo AO, Lanza E, Schatzkin A, Schoen RE. Ongoing colorectal cancer risk despite surveillance colonoscopy: the Polyp Prevention Trial Continued Follow-up Study. Gastrointest Endosc. 2010; 71:111–117.

5. Kaminski MF, Regula J, Kraszewska E, et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med. 2010; 362:1795–1803.

6. Pohl H, Robertson DJ. Colorectal cancers detected after colonoscopy frequently result from missed lesions. Clin Gastroenterol Hepatol. 2010; 8:858–864.

7. Sawhney MS, Farrar WD, Gudiseva S, et al. Microsatellite instability in interval colon cancers. Gastroenterology. 2006; 131:1700–1705.

8. Robertson DJ, Lieberman DA, Winawer SJ, et al. 795 interval cancer after total colonoscopy: results from a pooled analysis of eight studies. Gastroenterology. 2008; 134:A–111. A-112.

9. Farrar WD, Sawhney MS, Nelson DB, Lederle FA, Bond JH. Colorectal cancers found after a complete colonoscopy. Clin Gastroenterol Hepatol. 2006; 4:1259–1264.

10. Higaki S, Hashimoto S, Harada K, et al. Longterm follow-up of large flat colorectal tumors resected endoscopically. Endoscopy. 2003; 35:845–849.

11. Lieberman DA, Weiss DG, Bond JH, Ahnen DJ, Garewal H, Chejfec G. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. N Engl J Med. 2000; 343:162–168.

12. Facciorusso A, Di Maso M, Serviddio G, et al. Factors associated with recurrence of advanced colorectal adenoma after endoscopic resection. Clin Gastroenterol Hepatol. 2016; 14:1148–1154.e4.

13. Facciorusso A, Di Maso M, Serviddio G, Vendemiale G, Muscatiello N. Development and validation of a risk score for advanced colorectal adenoma recurrence after endoscopic resection. World J Gastroenterol. 2016; 22:6049–6056.

14. Seo JY, Chun J, Lee C, et al. Novel risk stratification for recurrence after endoscopic resection of advanced colorectal adenoma. Gastrointest Endosc. 2015; 81:655–664.

15. Walsh RM, Ackroyd FW, Shellito PC. Endoscopic resection of large sessile colorectal polyps. Gastrointest Endosc. 1992; 38:303–309.

16. Shinya H, Wolff WI. Morphology, anatomic distribution and cancer potential of colonic polyps. Ann Surg. 1979; 190:679–683.

17. DiSario JA, Foutch PG, Mai HD, Pardy K, Manne RK. Prevalence and malignant potential of colorectal polyps in asymptomatic, average-risk men. Am J Gastroenterol. 1991; 86:941–945.

18. O'Brien MJ, Winawer SJ, Zauber AG, et al. The National Polyp Study. Patient and polyp characteristics associated with high-grade dysplasia in colorectal adenomas. Gastroenterology. 1990; 98:371–379.

19. Siegel R, Desantis C, Jemal A. Colorectal cancer statistics, 2014. CA Cancer J Clin. 2014; 64:104–117.

20. Zauber AG, Winawer SJ, O'Brien MJ, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012; 366:687–696.

21. Taniguchi L, Higurashi T, Uchiyama T, et al. Metabolic factors accelerate colorectal adenoma recurrence. BMC Gastroenterol. 2014; 14:187.

22. Pommergaard HC, Burcharth J, Rosenberg J, Raskov H. Advanced age is a risk factor for proximal adenoma recurrence following colonoscopy and polypectomy. Br J Surg. 2016; 103:e100–e105.