Advanced Neoplasm Detection and Its Associated Factors in Colonoscopic Surveillance of Endoscopically Resected Early Colorectal Cancer

Soon Ha Kwon; Jin Woo Choo; Hyun Gun Kim; Seong Ran Jeon; Byung Hoo Lee; Tae Hee Lee; Wan Jung Kim; Bong Min Ko; Jin-Oh Kim; Joo Young Cho; Joon Seong Lee; Moon Sung Lee

doi:10.4166/kjg.2013.62.4.219

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Kwon, Choo, Kim, Jeon, Lee, Lee, Kim, Ko, Kim, Cho, Lee, and Lee: Advanced Neoplasm Detection and Its Associated Factors in Colonoscopic Surveillance of Endoscopically Resected Early Colorectal Cancer

Original Article

Korean J Gastroenterol 2013;62(4):219-226.

Published online: 4 October 2013

DOI: https://doi.org/10.4166/kjg.2013.62.4.219

Advanced Neoplasm Detection and Its Associated Factors in Colonoscopic Surveillance of Endoscopically Resected Early Colorectal Cancer

Soon Ha Kwon, Jin Woo Choo, Hyun Gun Kim, Seong Ran Jeon, Byung Hoo Lee, Tae Hee Lee, Wan Jung Kim, Bong Min Ko, Jin-Oh Kim, Joo Young Cho, Joon Seong Lee, Moon Sung Lee

Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea

Correspondence to: Jin-Oh Kim, Institute for Digestive Research, Department of Internal Medicine, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsan-gu, Seoul 140-743, Korea. Tel: +82-2-709-9202, Fax: +82-2-709-9696, E-mail: jokim@schmc.ac.kr

Received 2 April 2013 Revised 5 August 2013 Accepted 6 August 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Early colon cancer can be effectively diagnosed and treated by colonoscopy, and surveillance colonoscopy is necessary to detect precursor lesions or new early colon cancer. We analyzed the surveillance results of patients with endoscopically resected early colon cancer to evaluate the detection rate of advanced neoplasia and its associated factors.

Methods

We conducted a retrospective study at Soonchunhyang University Seoul Hospital, from May 2003 to December 2011. Patients who underwent endoscopic resection for early colon cancer, showed mucosal and submucosal invasion on histopathologic examination, and received surveillance colonoscopy at least once were enrolled in the current study. Patients who underwent operation and those who were lost during surveillance period were excluded.

Results

Among a total of 305 patients diagnosed with early colon cancer, 211 patients met our inclusion criteria. Of these patients, 15 (7.1%) advanced neoplasias were detected at first colonoscopy. One hundred ninety-eight patients (93.8%) underwent surveillance colonoscopy within one year and 14 (7.0%) advanced neoplasias were detected in this group of patients. When patients with and without advanced neoplasia at first surveillance colonoscopy performed within one year were compared, inadequate bowel preparation (OR, 18.237; 95% CI, 3.741–88.895; p<0.001) and three or more colon polyps (OR, 9.479; 95% CI, 1.103–81.452; p=0.040) were significant risk factors for detecting advanced neoplasia.

Conclusions

Considering the high detection rate of advanced neoplasia at first surveillance colonoscopy in patients with endoscopically resected early colon cancer, surveillance interval should be within one year, especially when the bowel preparation has been inadequate and three or more colon polyps have been detected.

Keywords: Colon polyps, Colon cancer, Colonoscopy, Surveillance

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Fig. 1.

Flow chart of surveillance colonoscopy analysis.

Fig. 2.

Analysis of advanced neoplasias in patients who underwent surveillance colonoscopy.

Table 1.

Comparison of Initial Endoscopic and Histologic Characteristics between Group A and B

Characteristic	Total (n=211)	Group A (n=14)	Group B (n=197)	p-value
Age (yr)	61.1±9.8	62.2±9.5	61.1±9.9	0.667
Sex (male)	149 (70.6)	9 (64.3)	140 (71.1)	0.558
Location
Right	57 (27.0)	3 (21.4)	54 (27.4)	0.763
Left	154 (72.9)	11 (78.6)	143 (72.6)
Size (mm)
＜10	39 (18.5)	3 (21.4)	36 (18.3)	0.726
≥10	172 (81.5)	11 (78.6)	161 (81.7)
Morphology
Polypoid	157 (74.4)	12 (85.7)	145 (73.6)	0.526
Non-polypoid	54 (25.6)	2 (14.3)	52 (26.4)
Number of polyps
＜3	84 (39.8)	1 (7.1)	83 (42.1)	0.010^a
≥3	127 (60.2)	13 (92.9)	114 (57.9)
BBPS
＜6	19 (9.0)	6 (42.9)	13 (6.6)	＜0.001^a
≥6	192 (90.9)	8 (57.1)	184 (93.4)
LVI
No	210 (99.5)	14 (100)	196 (99.5)	＞0.999
Yes	1 (0.5)	0 (0)	1 (0.5)
Resection margin
Negative	197 (93.4)	14 (100)	183 (92.9)	0.605
Positive	14 (6.6)	0 (0)	14 (7.1)
Death
Mucosa	179 (84.8)	12 (85.7)	167 (84.8)	＞0.999
SM1	32 (15.2)	2 (14.3)	30 (15.2)

Values are presented as mean±SD or n (%).

Group A, a group in which advanced neoplasias were detected at first surveillance colonoscopy within one year; group B, a group that does not include group A. BBPS, Boston Bowel Preparation Scale; LVI, lymphovascular invasion; SM1, submucosal 1 (<1,000 μ m).

^a Statistically significant.

Table 2.

Multivariate Analysis of Independent Factors for Detecting Advanced Neoplasia at First Surveillance Colonoscopy within One Year

Category	Univariate analysis (p-value)	Multivariate analysis
Category	Univariate analysis (p-value)	OR (95% CI)	p-value^a
Site	0.763	NA	NA
Morphology	0.526	NA	NA
Polyp size (mm)	0.726	NA	NA
Total polyps	0.010	9.479	0.040
(≥3 polyps)		(1.103–81.452)
Poor bowel	＜0.001	18.237	＜0.001
preparation		(3.741–88.895)

NA, not available.

^a Statistically significant.

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ORCID iDs: Seong Ran Jeon
https://orcid.org/http://orcid.org/0000-0001-6970-9737
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