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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.
References
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Fig. 1.
Flow diagram for the study. EMR, endoscopic mucosal resection; ESD, endoscopic submucosal dissection.
Table 1.
Characteristics of Patients with Incompletely Resected Advanced Colorectal Adenoma
| Parameters | Patients (n=163) |
|---|---|
| Age a | 66.5±10.0 |
| Sex (Male: Female) | 106: 57 |
| Current or ex-smoker, n (%) | 43 (26.3) |
| Alcohol, n (%) | 44 (26.9) |
| Indication, n (%) | |
| Screening | 103 (63.1) |
| Polyp or cancer surveillance | 13 (7.9) |
| Bleeding/Anemia | 13 (7.9) |
| Others | 34 (20.8) |
| Underlying disease, n (%) | |
| Hypertension | 56 (34.3) |
| Type 2 DM | 22 (13.4) |
| Vascular disease | 14 (8.5) |
| History of malignancy | 11 (6.7) |
| Others | 27 (16.5) |
Table 2.
Characteristics of Incompletely Resected Advanced Colorectal Adenoma
| Parameters | Patients (n=163) |
|---|---|
| Advanced colorectal adenoma type, n (%) | |
| Villous component | 90 (55.2) |
| Severe dysplasia (HGD) | 12 (7.3) |
| Greater than 10 mm in diameter | 61 (37.4) |
| Morphology, sessile polyps, n (%) | 114 (69.9) |
| Size, mm, n (%) | |
| 5–9 mm | 39 (23.9) |
| 10–20 mm | 112 (68.7) |
| >20 mm | 12 (7.3) |
| Mean sizea | 12.3±6.7 |
| Location, n (%) | |
| Right colon b | 90 (55.2) |
| Left colon b | 73 (44.7) |
| Recurrence, n (%) | 31 (19.0) |
Table 3.
Univariate Analysis for the Risk Factors of Recurrence after Incomplete Resection
| Variables | Recurrence rate of incompletely resected ACA a | p-value |
|---|---|---|
| Sex | 0.441 | |
| Male (n=106) | 20.8 (22/106) | |
| Female (n=57) | 15.8 (9/57) | |
| Age | 0.022 | |
| <70 years (n=98) | 13.3 (13/98) | |
| ≥70 years (n=65) | 27.7 (18/65) | |
| ACA type | 0.137 | |
| Pathologic criteria (n=102) | 22.5 (23/102) | |
| Size criteria (n=61) | 13.1 (8/61) | |
| Adenoma morphology | 0.021 | |
| Sessile (n=114) | 23.7 (27/114) | |
| Others (n=49) | 8.2 (4/49) | |
| Adenoma size | 0.572 | |
| <20 mm (n=140) | 20.0 (28/140) | |
| ≥20 mm (n=23) | 13.0 (3/23) | |
| Location of adenoma | 0.450 | |
| Right side colon (n=90) | 21.1 (19/90) | |
| Left side colon (n=73) | 16.4 (12/73) | |
| Enbloc vs. Piecemeal | 0.966 | |
| Enbloc (n=131) | 19.1 (25/131) | |
| Piecemeal (n=32) | 18.8 (6/32) | |
| Resection method | 0.584 | |
| EMR (n=158) | 19.6 (31/158) | |
| ESD (n=5) | 0 (0/5) | |
| Rescue therapy | 0.049 | |
| Yes (n=24) | 4.2 (1/24) | |
| No (n=139) | 21.6 (30/139) | |
| Bowel preperation | 0.345 | |
| Good or Fair (n=161) | 18.6 (30/161) | |
| Poor (n=2) | 50 (1/2) |
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