Risk and Cause of Interval Colorectal Cancer after Colonoscopic Polypectomy

• Published in: Digestion Vol. 86; no. 2; pp. 148 - 154
• Main Authors: Huang, Yinglong, Gong, Wei, Su, Bingzhong, Zhi, Fachao, Liu, Side, Jiang, Bo
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01.01.2012
• Subjects: Adenoma - diagnosis; Adenoma - surgery; Adenoma, Villous - diagnosis; Adenoma, Villous - surgery; Adult; Age Factors; Aged; Carcinoma - diagnosis; Carcinoma - epidemiology; Carcinoma - etiology; Cohort Studies; Colonic Polyps - diagnosis; Colonic Polyps - surgery; Colonoscopy; Colorectal cancer; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - epidemiology; Colorectal Neoplasms - etiology; Diagnostic Errors; Female; Follow-Up Studies; Humans; Incidence; Male; Medical Errors; Middle Aged; Original Paper; Precancerous Conditions - diagnosis; Precancerous Conditions - surgery; Retrospective Studies; Risk Factors; Polypectomy; Interval colorectal cancer; Adenoma; Surveillance
• DOI: 10.1159/000338680
• ISSN: 0012-2823

Background: To investigate the cause and risk of interval colorectal cancer (ICC) in patients undergoing surveillance colonoscopy within 5 years after colonoscopic polypectomy. Patients and Methods: We retrospectively analyzed data (endoscopy, pathology, demography) of patients who received surveillance colonoscopy within 5 years after colonoscopic polypectomy. Results: Among 1,794 patients undergoing surveillance colonoscopy within 5 years after colonoscopic polypectomy, 14 suffered from ICC. The mean follow-up time was 2.67 years and the incidence density of ICC was 2.9 cases per 1,000 person-years. 50% of ICCs were found in patients in whom adenomas had been incompletely removed by endoscopic therapy, 36% were missed cancers, and 14% were new cancers. Age >60 years (OR 2.97, 95% CI 2.31–3.82) was significantly associated with interval cancer on the surveillance colonoscopy as were advanced adenoma (OR 1.28, 95% CI 1.01–1.62), the presence of villous (HR 1.38, 95% CI 1.03–1.85) and high-grade dysplasia (OR 1.61, 95% CI 1.07–2.42). Conclusions: Among patients undergoing surveillance colonoscopy within 5 years after polypectomy, the incidence density of ICC was 2.9 cases per 1,000 person-years. The majority of interval cancers originated from incomplete resection of advanced adenomas and missed cancers, which can be prevented by improving endoscopic techniques and selecting an appropriate follow-up time interval.