Recurrence of Colorectal Neoplastic Polyps After Incomplete Resection,Annals of Internal Medicine

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Recurrence of Colorectal Neoplastic Polyps After Incomplete Resection
Annals of Internal Medicine ( IF 19.6 ) Pub Date : 2021-08-10 , DOI: 10.7326/m20-6689
Heiko Pohl ₁ , Joseph C Anderson ₂ , Andres Aguilera-Fish ₃ , Audrey H Calderwood ₄ , Todd A Mackenzie ₅ , Douglas J Robertson ₂

Affiliation

**Visual Abstract. Recurrence of Neoplastic Polyps After Incomplete Resection.**
Completeness of colorectal polyp resection has been considered as an important quality indicator for colonoscopy. The authors of this previously reported that about 10% of the colorectal polyps were incompletely resected in their practice, but there has been a dearth of direct evidence regarding what effect incomplete polyp resection has on the subsequent risk for colorectal neoplasia. In this study, the authors extend their prior work by evaluating whether incomplete resection of colorectal polyps would increase the risk for metachronous colorectal neoplasia. The results underscore the critical importance of polyp resection technique in efforts to improve colonoscopy quality.

Background:

Incomplete resection of neoplastic polyps is considered an important reason for the development of colorectal cancer. However, there are no data on the natural history of polyps that were incompletely removed.

Objective:

To examine the risk for metachronous neoplasia during surveillance colonoscopy after documented incomplete polyp resection.

Design:

Observational cohort study of patients who participated in the CARE (Complete Adenoma REsection) study (2009 to 2012).

Setting:

2 academic medical centers.

Patients:

Patients who had resection of a 5- to 20-mm neoplastic polyp, had a documented complete or incomplete resection, and had a surveillance examination.

Measurements:

Segment metachronous neoplasia, defined as the proportion of colon segments with at least 1 neoplastic polyp at first surveillance examination, was measured. Segment metachronous neoplasia was compared between segments with a prior incomplete polyp resection (incomplete segments) and those with a prior complete resection (complete segments), accounting for clustering of segments within patients.

Results:

Of 233 participants in the original study, 166 (71%) had at least 1 surveillance examination. Median time to surveillance was shorter after incomplete versus complete resection (median, 17 vs. 45 months). The risk for any metachronous neoplasia was greater in segments with incomplete versus complete resection (52% vs. 23%; risk difference [RD], 28% [95% CI, 9% to 47%]; P = 0.004). Incomplete segments also had a greater number of neoplastic polyps (mean, 0.8 vs. 0.3; RD, 0.50 [CI, 0.1 to 0.9]; P = 0.008) and greater risk for advanced neoplasia (18% vs. 3%; RD, 15% [CI, 1% to 29%]; P = 0.034). Incomplete resection was the strongest independent factor associated with metachronous neoplasia (odds ratio, 3.0 [CI, 1.12 to 8.17]).

Limitation:

Potential patient selection bias due to incomplete follow-up.

Conclusion:

This natural history study found a statistically significantly greater risk for future neoplasia and advanced neoplasia in colon segments after incomplete resection compared with segments with complete resection.

Primary Funding Source:

None.

中文翻译：

结直肠肿瘤性息肉不完全切除后复发

**视觉摘要。不完全切除后肿瘤性息肉的复发。**

结直肠息肉切除的完整性被认为是结肠镜检查的重要质量指标。该文章的作者之前曾报道，在他们的实践中，大约 10% 的结直肠息肉被不完全切除，但缺乏直接证据来说明不完全息肉切除对随后结直肠肿瘤风险的影响。在这项研究中，作者通过评估结直肠息肉的不完全切除是否会增加异时性结直肠肿瘤的风险来扩展他们之前的工作。结果强调了息肉切除技术对于提高结肠镜检查质量的至关重要性。

背景：

肿瘤性息肉切除不彻底被认为是结直肠癌发生的重要原因。然而，没有关于不完全切除的息肉的自然史的数据。

客观的：

在记录的不完全息肉切除术后监测结肠镜检查期间检查异时性肿瘤的风险。

设计：

参加 CARE（完全腺瘤切除）研究（2009 年至 2012 年）的患者的观察性队列研究。

环境：

2个学术医疗中心。

患者：

切除了 5 至 20 毫米肿瘤性息肉、有完整或不完整切除记录并进行了监测检查的患者。

测量：

测量了节段异时性肿瘤，定义为首次监测检查时至少有 1 个肿瘤性息肉的结肠节段的比例。比较先前不完全息肉切除的节段（不完整节段）和先前完全切除的节段（完整节段）之间的节段异时性肿瘤，考虑患者体内节段的聚集。

结果：

在原始研究的 233 名参与者中，166 名（71%）至少接受过 1 次监测检查。与完全切除相比，不完全切除后的中位监测时间更短（中位为 17 个月与 45 个月）。不完全切除的节段与完全切除的节段发生异时性肿瘤的风险更大（52% vs. 23%；风险差异 [RD]，28% [95% CI，9% 至 47%]； P = 0.004）。不完整节段的肿瘤性息肉数量也较多（平均值为 0.8 vs. 0.3；RD，0.50 [CI，0.1 至 0.9]； P = 0.008），晚期肿瘤风险较高（18% vs. 3%；RD，15） % [CI，1% 至 29%]； P = 0.034）。不完全切除是与异时性肿瘤相关的最强独立因素（比值比，3.0 [CI，1.12 至 8.17]）。