Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Mar 10, 2016; 8(5): 276-281
Published online Mar 10, 2016. doi: 10.4253/wjge.v8.i5.276
Endoscopic mucosal resection of colorectal adenomas > 20 mm: Risk factors for recurrence
Alexander Briedigkeit, Omar Sultanie, Bernd Sido, Franz Ludwig Dumoulin
Alexander Briedigkeit, Omar Sultanie, Franz Ludwig Dumoulin, Department of Medicine and Gastroenterology, Gemeinschaftskrankenhaus Bonn, 53113 Bonn, Germany
Bernd Sido, Department of General and Abdominal Surgery, Gemeinschaftskrankenhaus Bonn, 53113 Bonn, Germany
Author contributions: Briedigkeit A collected and analyzed the data, and drafted the manuscript; Sultanie O and Sido B provided analytical oversight; Dumoulin FL performed EMRs and designed and supervised the study; all authors have read and approved the final version to be published.
Institutional review board statement: The study was approved by the Institutional Review Board of the Gemeinschaftskrankenhaus Bonn (Chair Bremekamp C). A formal ethical approval is not required for retrospective studies by German Federal Law. This statement may be verified by contacting the chairman of the Ethics Committee of the University of Bonn (Professor Racké K, email: ethik@uni-bonn.de).
Informed consent statement: All patients gave informed consent for an anonymized data analysis along with the informed consent for interventional endoscopy. According to German Federal Law informed consent of patients is not required for retrospective data analysis.
Conflict-of-interest statement: The authors have no conflict of interest to disclose.
Data sharing statement: An anonymized dataset is available from the corresponding author at the email address given below.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Franz Ludwig Dumoulin, MD, PhD, Department of Medicine and Gastroenterology, Gemeinschaftskrankenhaus Bonn, Bonner Talweg 4-6, 53113 Bonn, Germany. f.dumoulin@gk-bonn.de
Telephone: +49-228-5081561 Fax: +49-228-5081562
Received: August 16, 2015
Peer-review started: August 17, 2015
First decision: September 23, 2015
Revised: October 21, 2015
Accepted: January 16, 2016
Article in press: January 19, 2016
Published online: March 10, 2016
Processing time: 200 Days and 12.8 Hours
Abstract

AIM: To evaluate risk factors for local recurrence after endoscopic mucosal resection of colorectal adenomas > 20 mm.

METHODS: Retrospective data analysis of 216 endoscopic mucosal resections for colorectal adenomas > 20 mm in 179 patients (40.3% female; median age 68 years; range 35-91 years). All patients had at least 1 follow-up endoscopy with a minimum control interval of 2 mo (mean follow-up 6 mo/2.0-43.4 mo). Possible factors associated with local recurrence were analyzed by univariate and multivariate analysis.

RESULTS: Median size of the lesions was 30 mm (20-70 mm), 69.0% were localized in the right-sided (cecum, ascending and transverse) colon. Most of the lesions (85.6%) showed a non-pedunculated morphology and the majority of resections was in piecemeal technique (78.7%). Histology showed carcinoma or high-grade intraepithelial neoplasia in 51/216 (23.6%) lesions including 4 low risk carcinomas (pT1a, L0, V0, R0 - G1/G2). Histologically proven recurrence was observed in 33/216 patients (15.3%). Patient age > 65 years, polyp size > 30 mm, non-pedunculated morphology, localization in the right-sided colon, piecemeal resection and tubular-villous histology were found as associated factors in univariate analysis. On multivariate analysis, only localization in the right-sided colon (HR = 6.842/95%CI: 1.540-30.394; P = 0.011), tubular-villous histology (HR = 3.713/95%CI: 1.617-8.528; P = 0.002) and polyp size > 30 mm (HR = 2.563/95%CI: 1.179-5.570; P = 0.017) were significantly associated risk factors for adenoma recurrence.

CONCLUSION: Meticulous endoscopic follow-up is warranted after endoscopic mucosal resection of adenomas localized in the right-sided colon larger than > 30 mm, with tubular-villous histology.

Keywords: Colorectal adenoma; Endoscopic mucosal resection; Piecemeal resection; Local recurrence rate; Tubular-villous adenoma

Core tip: Endoscopic mucosal resection of larger adenomas is burdened with relatively high rates of local recurrence. In this retrospective analysis, size > 30 mm, non-pedunculated morphology, right-sided localization, piecemeal resection and histology were all associated with local recurrence. In addition, right-sided localization, tubular-villous histology and size > 30 mm were independently associated with local recurrence. These findings emphasize the necessity of meticulous endoscopic follow-up, they might also argue in favor of en bloc resection of larger colorectal lesions, in particular in the right-sided colon.