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Novel risk stratification developed for advanced colorectal adenoma recurrence after resection
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Researchers have identified predictive risk factors for local recurrence of advanced colorectal adenoma and development of metachronous advanced neoplasm after endoscopic resection.
Aiming to determine patient outcomes after endoscopic resection of advanced colorectal adenomas (ACA) and to identify risk factors for local recurrence and metachronous advanced neoplasm, researchers from Korea retrospectively reviewed medical records of 3,625 patients who underwent colonoscopic polypectomy at Seoul National University Hospital from 2005 to 2011.
They focused on evaluating risk based on the number of ACA predictive characteristics including age, sex, adenoma characteristics, endoscopic procedure and pathology data. Endoscopic procedures used included endoscopic mucosal resection, endoscopic submucosal dissection and piecemeal resection.
For the 917 patients (mean age, 61.3 years; 73.1% men) with 1,206 ACAs included in the final analysis, the median duration of follow-up was 28.5 months (interquartile range [IQR], 12.8-51.7). Local recurrence occurred in 3.6% at a median of 12.7 months (IQR, 6.1-24). Metachronous advanced neoplasms occurred in 13.8% at a median of 18 months (IQR, 12.1-39.7) after resection.
Independent risk factors for local recurrence included two or more ACA predictive characteristics (adjusted HR=2.46; 95% CI, 1.11-5.48) and piecemeal resection vs. en bloc resection (adjusted HR=6.96; 95% CI, 1.58-30.71). Independent risk factors for metachronous advanced neoplasm included male gender (adjusted HR=1.65; 95% CI, 1.02-2.65), three or more adenomas (adjusted HR =2.56; 95% CI, 1.72-3.82) and three or more ACAs (adjusted HR=1.44; 95% CI, 1.01-2.06).
“Patients with adenomas with two or three ACA predictive characteristics have a higher risk of local recurrence after endoscopic resection than those with adenomas with one predictive characteristic,” the researchers concluded. “Therefore, we suggest a surveillance interval shorter than 3 years for patients who have undergone endoscopic resection for adenomas with two or three ACA predictive characteristics.”
Disclosure: The researchers report no relevant financial disclosures.
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