Colonoscopy surveillance for high risk polyps does not always prevent colorectal cancer

作     者：Mohamad A Mouchli Lidia Ouk Marianne R Scheitel Alisha P Chaudhry Donna Felmlee-Devine Diane E Grill Shahrooz Rashtak Panwen Wang Junwen Wang Rajeev Chaudhry Thomas C Smyrk Ann L Oberg Brooke R Druliner Lisa A Boardman 

作者机构：Division of Gastroenterology and Hepatology Mayo Clinic Knowledge and Delivery Center Mayo Clinic Biostatistics and Bioinformatics Health Sciences Research Mayo Clinic Division of Biomedical Statistics and Informatics Health Sciences Research Mayo Clinic Biostatistics and Bioinformatics Health Science Research Center for Individualized Medicine Mayo Clinic Department of Biomedical Informatics Arizona State University Primary Care Internal Medicine Mayo Clinic Center for Innovation Mayo Clinic Department of Laboratory Medicine and Pathology Mayo Clinic 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2018年第24卷第8期

页      面：905-916页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

基　　金：Supported by the National Cancer Institute,No.CA170357 the Mayo Clinic Center for Cell Signaling in Gastroenterology,NIDDK Mo.P30DK084567 

主　　题：Colon cancer Rectal Cancer Advanced adenoma Sessile serrated adenoma High risk polyps Post-polypectomy colorectal cancer 

摘      要：AIM To determine the frequency and risk factors for colorectal cancer(CRC) development among individuals with resected advanced adenoma(AA)/traditional serrated adenoma(TSA)/advanced sessile serrated adenoma(ASSA). METHODS Data was collected from medical records of 14663 subjects found to have AA, TSA, or ASSA at screening or surveillance colonoscopy. Patients with inflammatory bowel disease or known genetic predisposition for CRC were excluded from the study. Factors associated with CRC developing after endoscopic management of high risk polyps were calculated in 4610 such patients who had at least one surveillance colonoscopy within 10 years following the original polypectomy of the incident advanced polyp. RESULTS84/4610(1.8%) patients developed CRC at the polypectomy site within a median of 4.2 years(mean 4.89 years), and 1.2%(54/4610) developed CRC in a region distinct from the AA/TSA/ASSA resection site within a median of 5.1 years(mean 6.67 years). Approximately, 30%(25/84) of patients who developed CRC at the AA/TSA/ASSA site and 27.8%(15/54) of patients who developed CRC at another site had colonoscopy at recommended surveillance intervals. Increasing age; polyp size; male sex; right-sided location; high degree of dysplasia; higher number of polyps resected; and piecemeal removal were associated with an increased risk for CRC developmentat the same site as the index polyp. Increasing age; right-sided location; higher number of polyps resected and sessile endoscopic appearance of the index AA/TSA/ASSA were significantly associated with an increased risk for CRC development at a different site. CONCLUSION Recognition that CRC may develop following AA/TSA/ASSA removal is one step toward improving our practice efficiency and preventing a portion of CRC related morbidity and mortality.