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Long-term outcomes and surveillance timing of patients with large non-pedunculated colorectal polyps with histologically incomplete resection in endoscopic resection

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A Correction to this article was published on 17 March 2021

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Abstract

Background

Histologically incomplete resection of large colorectal polyps is frequently encountered; however, the long-term outcomes or surveillance timing is not well known. We evaluated the incidence rate and time of recurrence of these cases during a long-term follow-up.

Methods

We performed a retrospective analysis of patients who underwent endoscopic resection for large (≥10 mm in size) non-pedunculated colorectal polyps at a tertiary academic hospital. Patients who had positive or indeterminate lateral margin in the histology and underwent completed surveillance colonoscopy first at 3–12 months and finally at ≥2 years after initial resection were included.

Results

Of 169 polyps (148 patients), 37 (21.9%) and 132 (78.1%) polyps had positive and indeterminate lateral margins, respectively. The median time intervals of the first and last surveillance from the initial resection were 6 (3–12) and 48 (24–114) months, respectively. The recurrence rate was 9.5% (16/169) during follow-up, and the mean time to recurrence was 31.9 months. Thirteen (81.3%) polyps recurred after ≥12 months. Most (14/16, 87.5%) recurrent polyps were benign, and 2 cases had advanced cancer. The only factor that was significantly associated with recurrence in the univariate and multivariate analyses was ≥3 piecemeal resections (odds ratio in the multivariate analysis, 16.92; 95% CI, 1.19–241.81; p = 0.037).

Conclusion

During the long-term follow-up, the only factor that was significantly associated with recurrence was ≥3 piecemeal resections, and most recurrences occurred after ≥12 months. Thus, a histologically incomplete resection with ≤2 piecemeal resections and no findings of suspected submucosal cancer may be considered as complete resection, and these patients may undergo first surveillance colonoscopy after 1–2 years.

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Funding

This study was supported by a 2-Year Research Grant of Pusan National University.

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    Authors and Affiliations

    1. Department of Internal Medicine, Gupo Sungshim Hospital, Busan, Korea

      Dong Ku Kang

    2. Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Beomeo-ri, Mulgeum-eup, Gyeongsangnam-do 626-770, Yangsan, Korea

      Su Bum Park, Hyung Wook Kim, Dae Hwan Kang, Cheol Woong Choi, Su Jin Kim, Hyeong Seok Nam & Dae Gon Ryu

    3. Department of Internal Medicine, Gwanghye General Hospital, Busan, Korea

      Jeong Seok Lee

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    Correspondence to Hyung Wook Kim.

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    Dong Ku Kang, Su Bum Park, Hyung Wook Kim, Dae Hwan Kang, Cheol Woong Choi, Su Jin Kim, Hyeong Seok Nam, Dae Gon Ryu, Jeong Seok Lee have no conflicts of interest.

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    Dong Ku Kang and Su Bum Park contributed equally to this work and share first authorship.

    The article was updated to include the Article Note that Dong Ku Kang and Su Bum Park contributed equally to this work and share first authorship.

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    Kang, D.K., Park, S.B., Kim, H.W. et al. Long-term outcomes and surveillance timing of patients with large non-pedunculated colorectal polyps with histologically incomplete resection in endoscopic resection. Surg Endosc 36, 1369–1378 (2022). https://doi.org/10.1007/s00464-021-08419-9

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