Recurrence with malignancy after endoscopic resection of large colon polyps with high-grade dysplasia: incidence and risk factors
- 29 May 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Surgical Endoscopy
- Vol. 35 (6), 2500-2508
- https://doi.org/10.1007/s00464-020-07660-y
Abstract
Background In the West, piecemeal endoscopic resection remains the primary treatment for large colon polyps (LCP), as most recurrences are believed to be benign and resectable with follow-up endoscopy. However, invasive malignancy at the site of prior piecemeal endoscopic mucosal resection has been reported in the Asian literature. This study aims to identify the incidence of and the risk factors for local recurrence with malignancy after endoscopic resection of LCP with high-grade dysplasia (HGD). Methods In this retrospective cohort study, we identified patients undergoing complete endoscopic resection of LCPs (≥ 20 mm) with HGD at the Cleveland Clinic between January 2000 and December 2016. Demographic, endoscopic, and pathologic data were collected. All subsequent endoscopic and pathology reports were reviewed to identify recurrence. The cumulative incidence of malignancy at the polypectomy site was determined and univariate analysis was performed to assess risk factors. Results A total of 254 LCPs with HGD were resected in 229 patients. Mean polyp size was 29.2 mm. There were 138 lesions resected in piecemeal fashion and 116 en-bloc. After a median follow-up of 28.7 months for the entire cohort, local recurrence with malignancy was diagnosed in six cases. Median time to malignancy diagnosis was 28.5 months. All malignant cases occurred after piecemeal resection and none after en-bloc resection (HR 11.4; 95% CI 0.48–273). Conclusion Malignancy after endoscopic resection of LCPs with HGD is uncommon and may be associated with piecemeal resection. When possible, en-bloc resection should be the goal for the management of LCPs.Keywords
This publication has 49 references indexed in Scilit:
- A large-scale multicenter study of long-term outcomes after endoscopic resection for submucosal invasive colorectal cancerEndoscopy, 2013
- Long-term Outcomes After Resection for Submucosal Invasive Colorectal CancersGastroenterology, 2013
- Current status of endoscopic resection strategy for large, early colorectal neoplasia in JapanSurgical Endoscopy, 2013
- Endoscopic treatment of large colorectal tumors: comparison of endoscopic mucosal resection, endoscopic mucosal resection–precutting, and endoscopic submucosal dissectionSurgical Endoscopy, 2012
- Long-term risk of colorectal cancer after adenoma removal: a population-based cohort studyGut, 2011
- Large Colorectal PolypsJournal of Clinical Gastroenterology, 2011
- Recurrent advanced colonic cancer occurring 11 years after initial endoscopic piecemeal resection: a case reportBMC Gastroenterology, 2010
- Recurrence after endoscopic piecemeal mucosal resection for large sessile colorectal polypsWorld Journal of Gastroenterology, 2010
- Meta-analysis and systematic review of colorectal endoscopic mucosal resectionWorld Journal of Gastroenterology, 2009
- Endoscopic snare excision of “giant” colorectal polypsGastrointestinal Endoscopy, 1996