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World J Gastroenterol. 2018 Feb 28;24(8):905-916. doi: 10.3748/wjg.v24.i8.905.

Colonoscopy surveillance for high risk polyps does not always prevent colorectal cancer.

Author information

1
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States.
2
Knowledge and Delivery Center, Mayo Clinic, Rochester, MN 55905, United States.
3
Biostatistics and Bioinformatics, Health Sciences Research, Mayo Clinic, Rochester, MN 55905, United States.
4
Division of Biomedical Statistics and Informatics, Health Sciences Research, Mayo Clinic, Rochester, MN 55905, United States.
5
Biostatistics and Bioinformatics, Health Science Research, Center for Individualized Medicine Mayo Clinic, Scottsdale, AZ 85259, United States.
6
Primary Care Internal Medicine, Mayo Clinic, Rochester, MN 55905, United States.
7
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, United States.
8
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States. boardman.lisa@mayo.edu.

Abstract

AIM:

To determine the frequency and risk factors for colorectal cancer (CRC) development among individuals with resected advanced adenoma (AA)/traditional serrated adenoma (TSA)/advanced sessile serrated adenoma (ASSA).

METHODS:

Data was collected from medical records of 14663 subjects found to have AA, TSA, or ASSA at screening or surveillance colonoscopy. Patients with inflammatory bowel disease or known genetic predisposition for CRC were excluded from the study. Factors associated with CRC developing after endoscopic management of high risk polyps were calculated in 4610 such patients who had at least one surveillance colonoscopy within 10 years following the original polypectomy of the incident advanced polyp.

RESULTS:

84/4610 (1.8%) patients developed CRC at the polypectomy site within a median of 4.2 years (mean 4.89 years), and 1.2% (54/4610) developed CRC in a region distinct from the AA/TSA/ASSA resection site within a median of 5.1 years (mean 6.67 years). Approximately, 30% (25/84) of patients who developed CRC at the AA/TSA/ASSA site and 27.8% (15/54) of patients who developed CRC at another site had colonoscopy at recommended surveillance intervals. Increasing age; polyp size; male sex; right-sided location; high degree of dysplasia; higher number of polyps resected; and piecemeal removal were associated with an increased risk for CRC development at the same site as the index polyp. Increasing age; right-sided location; higher number of polyps resected and sessile endoscopic appearance of the index AA/TSA/ASSA were significantly associated with an increased risk for CRC development at a different site.

CONCLUSION:

Recognition that CRC may develop following AA/TSA/ASSA removal is one step toward improving our practice efficiency and preventing a portion of CRC related morbidity and mortality.

KEYWORDS:

Advanced adenoma; Colon cancer; High risk polyps; Post-polypectomy colorectal cancer; Rectal Cancer; Sessile serrated adenoma

PMID:
29491684
PMCID:
PMC5829154
DOI:
10.3748/wjg.v24.i8.905
[Indexed for MEDLINE]
Free PMC Article

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