BACKGROUND: Advanced colorectal adenoma (ACA) refers to adenomas with the following predictive characteristics: ≥1 cm in diameter, and/or villous component, and/or high-grade dysplasia. ACA has high risk of transforming to colorectal cancer, and the recurrence rate is relatively high. OBJECTIVE: To assess the outcomes of patients with ACA undergoing endoscopic resection and to identify risk factors for local recurrence and development of metachronous advanced neoplasm. DESIGN: Retrospective cohort study. SETTING: Tertiary care medical center. PATIENTS: From 2005 to 2011, the records of 3625 patients who underwent colonoscopic polypectomy at Seoul National University Hospital were retrospectively reviewed. Patients with synchronous colorectal cancers, inflammatory bowel disease, previous colorectal resection, loss to follow-up, and incomplete resection were excluded. INTERVENTION: Endoscopic resection for ACA. MAIN OUTCOME MEASUREMENTS: Local recurrence and metachronous advanced neoplasm. RESULTS: The study included 917 patients with 1206 ACAs. The median duration of follow-up was 28.5 months (interquartile range, 12.8-51.7). Independent risk factors for local recurrence included ACA with 2 or more predictive characteristics (adjusted hazard ratio [HR], 2.46; 95% confidence interval [CI], 1.11-5.48; P = .027) and piecemeal resection (adjusted HR, 6.96; 95% CI, 1.58-30.71; P = .010). Independent risk factors for metachronous advanced neoplasm were male gender (adjusted HR, 1.65; 95% CI, 1.02-2.65; P = .041), ≥3 adenomas (adjusted HR, 2.56; 95% CI, 1.72-3.82; P < .001), and ≥3 ACAs (adjusted HR, 1.44; 95% CI, 1.01-2.06; P = .045). LIMITATIONS: Retrospective design. CONCLUSION: ACAs with 2 or more predictive characteristics recurred locally at a higher rate than ACAs with 1 predictive characteristic. These results suggest that patients who are found to have ACAs with 2 or more predictive factors at index colonoscopy are at higher risk for local recurrence, and follow-up colonoscopy should be performed sooner.
BACKGROUND: Advanced colorectal adenoma (ACA) refers to adenomas with the following predictive characteristics: ≥1 cm in diameter, and/or villous component, and/or high-grade dysplasia. ACA has high risk of transforming to colorectal cancer, and the recurrence rate is relatively high. OBJECTIVE: To assess the outcomes of patients with ACA undergoing endoscopic resection and to identify risk factors for local recurrence and development of metachronous advanced neoplasm. DESIGN: Retrospective cohort study. SETTING: Tertiary care medical center. PATIENTS: From 2005 to 2011, the records of 3625 patients who underwent colonoscopic polypectomy at Seoul National University Hospital were retrospectively reviewed. Patients with synchronous colorectal cancers, inflammatory bowel disease, previous colorectal resection, loss to follow-up, and incomplete resection were excluded. INTERVENTION: Endoscopic resection for ACA. MAIN OUTCOME MEASUREMENTS: Local recurrence and metachronous advanced neoplasm. RESULTS: The study included 917 patients with 1206 ACAs. The median duration of follow-up was 28.5 months (interquartile range, 12.8-51.7). Independent risk factors for local recurrence included ACA with 2 or more predictive characteristics (adjusted hazard ratio [HR], 2.46; 95% confidence interval [CI], 1.11-5.48; P = .027) and piecemeal resection (adjusted HR, 6.96; 95% CI, 1.58-30.71; P = .010). Independent risk factors for metachronous advanced neoplasm were male gender (adjusted HR, 1.65; 95% CI, 1.02-2.65; P = .041), ≥3 adenomas (adjusted HR, 2.56; 95% CI, 1.72-3.82; P < .001), and ≥3 ACAs (adjusted HR, 1.44; 95% CI, 1.01-2.06; P = .045). LIMITATIONS: Retrospective design. CONCLUSION: ACAs with 2 or more predictive characteristics recurred locally at a higher rate than ACAs with 1 predictive characteristic. These results suggest that patients who are found to have ACAs with 2 or more predictive factors at index colonoscopy are at higher risk for local recurrence, and follow-up colonoscopy should be performed sooner.
Authors: J Seidel; E Färber; R Baumbach; W Cordruwisch; U Böhmler; B Feyerabend; S Faiss Journal: Int J Colorectal Dis Date: 2016-01-12 Impact factor: 2.571
Authors: Lin Liu; Karen Messer; John A Baron; David A Lieberman; Elizabeth T Jacobs; Amanda J Cross; Gwen Murphy; Maria Elena Martinez; Samir Gupta Journal: Cancer Causes Control Date: 2016-08-12 Impact factor: 2.506
Authors: Colin J Rees; Roisin Bevan; Katharina Zimmermann-Fraedrich; Matthew D Rutter; Douglas Rex; Evelien Dekker; Thierry Ponchon; Michael Bretthauer; Jaroslaw Regula; Brian Saunders; Cesare Hassan; Michael J Bourke; Thomas Rösch Journal: Gut Date: 2016-10-08 Impact factor: 23.059
Authors: Ji Yeon Seo; Seung Ho Choi; Jaeyoung Chun; Changhyun Lee; Ji Min Choi; Eun Hyo Jin; Sung Wook Hwang; Jong Pil Im; Sang Gyun Kim; Joo Sung Kim Journal: Intest Res Date: 2016-06-27