Recurrence and surveillance of colorectal adenoma after polypectomy in a southern Chinese population
- 316 Downloads
Background and aim
Repeat colonoscopy is often performed within a short time after polypectomy due to the fear that colorectal adenomas were missed during the initial colonoscopy or that new adenomas have developed. The aim of this study was to estimate the actual recurrence rate of adenoma and its association with the length of the surveillance interval after polypectomy in a southern Chinese population.
A total of 1356 patients undergoing endoscopic polypectomy and completing three or more surveillence colonoscopies between 1976 and 2007 were retrospectively analyzed. The recurrence rates of adenoma and advanced adenoma and surveillance intervals after polypectomy were identified based on the features of adenomas detected on initial colonoscopy.
The recurrence rates of advanced adenoma in patients with non-advanced adenoma on the initial colonoscopy were 0.9, 3.9, 5.8, and 29.2% during surveillance intervals of 1–3, 3–5, 5–10, and 10–20 years post-initial colonoscopy; for patients with advanced adenoma on the initial colonoscopy, the recurrence rates were 3.8, 13.1, 34.7, and 52.0% during the same surveillance intervals, respectively. Older age (p < 0.05 for trend) and male sex [hazard ratio (HR) 2.11, 95% confidence interval (CI) 1.27–3.53] were significantly associated with recurrence for advanced adenoma, as were the size and number of baseline adenoma (p < 0.05 for trend), tubulovillous, villous adenoma (HR 2.57, 95% CI 1.24–5.32), and high-grade dysplasia (HR 1.61, 95% CI 1.07–2.42). When 5% of patients had recurring advanced adenoma, the surveillance interval was estimated to be 6.9 (95% CI 6.3–12.2) years in the low-risk group and 3.0 (95% CI 2.7–3.2) years in the high-risk group.
Among our patient group, the recurrence of advanced adenoma after polypectomy increased with the length of the surveillance interval. Based on our results, a 3-year follow-up of patients after polypectomy could be effective in preventing the recurrence of advanced adenoma in high-risk patients.
KeywordsColorectal adenoma Polypectomy Recurrence Surveillance
- 4.Winawer SJ, Zauber AG, Fletcher RH, Stillman JS, O’Brien MJ, Levin B, et al. Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. CA Cancer J Clin. 2006;56:143–59 (quiz 184–5).CrossRefPubMedGoogle Scholar
- 12.Leung K, Pinsky P, Laiyemo AO, Lanza E, Schatzkin A, Schoen RE. Ongoing colorectal cancer risk despite surveillance colonoscopy: the Polyp Prevention Trial Continued Follow-up Study. Gastrointest Endosc. 2009;71:111–7.Google Scholar
- 16.Hamilton SR, Vogelstein B, Kudo S. Carcinoma of the colon and rectum. In: Hamilton SR, Altonen IA, editors. Tumours of the digestive system. WHO classification of tumors. Lyon: IARC Press; 2000. p. 113–4.Google Scholar
- 17.Sauerbrei W. The use of resampling methods to simplify regression models in medical statistics. Appl Stat. 1999;48:313–29.Google Scholar
- 31.Reid ME, Marshall JR, Roe D, Lebowitz M, Alberts D, Battacharyya AK, et al. Smoking exposure as a risk factor for prevalent and recurrent colorectal adenomas. Cancer Epidemiol Biomark Prev. 2003;12:1006–11.Google Scholar