Published online Mar 10, 2016. doi: 10.4253/wjge.v8.i5.276
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
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.
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.