Pathologic Features of Initial Adenomas as Predictors for Metachronous Adenomas of the Rectum
04 Nov 1998-Journal of the National Cancer Institute (Oxford University Press)-Vol. 90, Iss: 21, pp 1661-1665
TL;DR: The risk of metachronous adenomas is closely related to the pathology of initial adenomatous polyps, thus allowing identification of a high-risk group of adenoma patients for close surveillance after their initial polypectomy.
Abstract: Background Colorectal cancer is the third most common cancer in the world, arising mostly from pre-existing adenomatous polyps (adenomas) of the large bowel. Patients with colorectal adenomas are at increased risk of colorectal cancer because of a high recurrence rate for adenomas. We followed a cohort of 1490 patients with rectal adenomas to determine whether recurrence might be related to pathologic characteristics of the initial adenomas. Methods The patients were identified in Haining County, China, from 1977 through 1978 by means of examination with a 15-cm rigid sigmoidoscope. They were followed by endoscopic examination at years 2, 4, 6, 11, and 16 after their initial polypectomy. New adenomas in the rectum were identified in 280 patients in these follow-up examinations. Results Statistically significant twofold to threefold elevated risks of metachronous (recurrent) adenomas were observed for patients who had more than two initial adenomas or whose most advanced initial adenoma was more than 1.0 cm in size, was of villous/tubulovillous type, or showed moderate to severe dysplasia. Much stronger associations were observed for advanced metachronous neoplasms, which are defined as cancers or adenomas with severe dysplasia, with multivariate adjusted relative risks (95% confidence interval) of 4.2 (1.8-9.9) for a large initial adenoma (>1.0 cm), 8.1 (4.2-15.6) for villous/tubulovillous architecture, and 14.4 (5.0-41.3) for severe dysplasia. In particular, patients who had a large (>1.0 cm) adenoma with severe dysplasia at baseline had a relative risk of 37 (7.8-174.7) of developing advanced metachronous neoplasms compared with patients who had small adenoma(s) with mild dysplasia. Conclusions The risk of metachronous adenomas is closely related to the pathology of initial adenomas, thus allowing identification of a high-risk group of adenoma patients for close surveillance after their initial polypectomy.
Citations
More filters
TL;DR: In Japan, further studies are recommended to establish an appropriate and original Japanese colonoscopy surveillance program for use after polypectomy, based on guidelines from the United States.
Abstract: The goal of surveillance examinations after polypectomy is to detect new adenomas and missed synchronous adenomas, as well as preventing adenomas from becoming invasive or cancerous. The first colonoscopy surveillance program reported was the National Polyp Study from the United States in 1997, with an update in 2003. First screening colonoscopy and polypectomy have been shown to produce the greatest effects in reducing the incidence of colorectal cancer in patients with adenomatous polyps. However, a large number of adenomas are being discovered as a result of the increased use of colorectal cancer screening, particularly with the dramatic increase in screening colonoscopy and surveillance. Increased efficiency of surveillance colonoscopy practices is therefore needed to decrease the cost, risk, and overuse of medical resources. In developing surveillance programs, studying miss rates and incidences and performing separate evaluations are important, along with accurately assessing incidence. This is because the recurrence rate or apparent incidence after colonoscopic polypectomy includes the true incidence of new polyp formation plus the incidence of missed polyps from the initial colonoscopy. Many studies have indicated the number of adenomas on initial examination as the most significant predictor for missed adenoma and incidence of adenoma on surveillance colonoscopy. In Japan, many facets of colonoscopic examination differ from those in Western countries. Further studies are recommended to establish an appropriate and original Japanese colonoscopy surveillance program for use after polypectomy, based on guidelines from the United States.
1 citations
Cites background from "Pathologic Features of Initial Aden..."
...Furthermore, high-grade dysplasia is related to larger adenoma size and villous component at baseline and is an important predictor for subsequent advanced neoplasia [6, 68]....
[...]
...[68] showed that larger adenoma size was related to subsequent risk of advanced neoplasia at surveillance....
[...]
Journal Article•
TL;DR: It is concluded that full examination of the colon in all patients presenting with primary colorectal cancer is mandatory and that, in the light of this experience and recent reports in the literature, this should be done by pre- or perioperative colonoscopy.
Abstract: The medical records of all patients with colorectal cancer seen at the "G. Marinaccio" Department of Surgery in Bari between 1997 and 2004 were examined. Cases included in the study met the criteria advocated by Warren and Gates and Moertel et al. Over such period we operated on 103 patients with colon neoplasms, mostly males (64 patients) and aged over 65 (64 patients). Both palliative and radical operations were performed either as elective treatment or as emergency surgery; in some of the latter cases the diagnosis of neoplasm was made casually following the final histological test on the operative specimen. Ten cases of multiple malignant tumours were recorded, corresponding to 9.7%; in particular 1 synchronous-metachronous tumour (0.97%), 3 synchronous tumours (2.7%) and 6 metachronous tumours (5.8%) were observed; two of the metachronous tumours were detected in the same patient and one in a patient that had previously been operated on for a synchronous carcinoma, thus making a total of 8 patients in all. It is concluded that full examination of the colon in all patients presenting with primary colorectal cancer is mandatory and that, in the light of this experience and recent reports in the literature, this should be done by pre- or perioperative colonoscopy. Colonoscopy not only provides accurate detection of lesions, but also allows the surgeon to perform polypectomies, thereby obviating the need for extending surgery at the time of resection of the coexisting cancer. In conclusion, we recommend preoperative colonoscopy for all patients who present non-obstructive colorectal neoplasms.
1 citations
30 Sep 2014
TL;DR: The importance of colonoscopy follow up after polypectomy was clearly emphasized through the cumulative recurrence rate of 55.8%.
Abstract: Objectives: Colonoscopy is a popular tool for screening for colon cancer throughout the world. The incidence of polypectomy and follow-up colonoscopy are persistently increasing but the studies about follow-up test after polypectomy are still lack of its domestic sources. This study is designed to look into the recurrence rate of colon polyps and risk factors after polypectomy. Methods: This is a retrospective study by reviewing medical charts of 147 patients who underwent polypectomy and follow-up colonoscopy from Jan. 2000 to Mar. 2008. The Kudo classification was used to describe the polyps found in the colonoscopy. The follow-up period was defined as the term between polypectomy and the first colonoscopy follow up. Results: Seventy six point two percent of the enrolled patient were male and the mean age was 56.5 ± 8.1. Mean follow-up period was 24.9 ± 13.7 (6 - 65) months. The cumulative recurrence rate of 1 year was 11.6%. The rate of 2 years was 36.7% and that of 3 years was 55.8%. The number of polyps was the factor which statistically showed significant relation of its recurrence rate. The histological morphology characteristic of polyps could be one independent factor which may be associated to the recurrence of polyps. Conclusions: The importance of colonoscopy follow up after polypectomy was clearly emphasized through the cumulative recurrence rate of 55.8%. Therefore, there is a need for more domestic studies with a large number of patients about the recurrence of polyps after polypectomy.
Additional excerpts
...또한 관상융모성 선종 혹은 융 모성 선종이나 중증의 이형성을 보이는 경우 용 종의 재발이 더 높다는 보고도 있다[22,23]....
[...]
...이전의 연구에 의하면 선종의 크기가 크면 대 장암의 발생빈도가 증가한다고 하였다[21,22]....
[...]
References
More filters
TL;DR: A model for the genetic basis of colorectal neoplasia that includes the following salient features is presented, which may be applicable to other common epithelial neoplasms, in which tumors of varying stage are more difficult to study.
11,576 citations
TL;DR: The results of the National Polyp Study support the view that colorectal adenomas progress to adenocarcinomas, as well as the current practice of searching for and removing adenomatous polyps to prevent coloreCTal cancer.
Abstract: Background The current practice of removing adenomatous polyps of the colon and rectum is based on the belief that this will prevent colorectal cancer. To address the hypothesis that colonoscopic polypectomy reduces the incidence of colorectal cancer, we analyzed the results of the National Polyp Study with reference to other published results. Methods The study cohort consisted of 1418 patients who had a complete colonoscopy during which one or more adenomas of the colon or rectum were removed. The patients subsequently underwent periodic colonoscopy during an average follow-up of 5.9 years, and the incidence of colorectal cancer was ascertained. The incidence rate of colorectal cancer was compared with that in three reference groups, including two cohorts in which colonic polyps were not removed and one general-population registry, after adjustment for sex, age, and polyp size. Results Ninety-seven percent of the patients were followed clinically for a total of 8401 person-years, and 80 percent returned...
4,310 citations
TL;DR: Evidence is presented which suggests that most cancers of the colon and rectum have evolved through the polyp‐cancer sequence although the majority of adenomas do not become cancerous during a normal adult life span.
Abstract: The malignant potential of adenomas of the colon and rectum varies with size, histological type and grade of epithelial atypia. The adenomatous polyp is usually small and has a low malignant potential, whereas tumors with a villous structure are usually larger and have a much higher cancer rate. Severe atypia is more common in villous adenomas than in adenomatous polyps. Evidence is presented which suggests that most cancers of the colon and rectum have evolved through the polyp-cancer sequence although the majority of adenomas do not becoma cancerous during a normal adult life span. The slow evolution of the polyp-cancer sequence is stressed. The implications of the polyp-cancer sequence for the design of cancer prevention programmes and the study of the aetiology of large bowel cancer are discussed.
1,944 citations
TL;DR: The long-term risk of colorectal cancer after rigid-instrument sigmoidoscopy and polypectomy in 1618 patients with rectosigmoid adenomas who did not undergo surveillance was assessed, finding that surveillance may not be of value because the risk of cancer is so low.
Abstract: Background and Methods Surveillance by repeated colonoscopy is currently recommended for patients with colorectal adenomas. We assessed the long-term risk of colorectal cancer after rigid-instrument sigmoidoscopy and polypectomy in 1618 patients with rectosigmoid adenomas (tumors of the rectum or distal sigmoid colon) who did not undergo surveillance. A total of 22,462 person-years of observation were accrued (mean, 14 years per patient). Results The incidence of subsequent rectal cancer in these patients was similar to that in the general population (standardized incidence ratio, 1.2; 95 percent confidence interval, 0.7 to 2.1). Most rectal cancers developed in patients whose adenomas had been inadequately removed; the risk was very low after complete removal. The risk of subsequent colon cancer depended on the histologic type, size, and number of adenomas in the rectosigmoid. Among 842 patients with a rectosigmoid adenoma that was tubulovillous, villous, or large (≥1 cm), colon cancer developed...
1,018 citations
TL;DR: Colonoscopy performed three years after colonoscopic removal of adenomatous polyps detects important colonic lesions as effectively as follow-up colonoscopy after both one and three years.
Abstract: Background The identification and removal of adenomatous polyps and post-polypectomy surveillance are considered to be important for the control of colorectal cancer. In current practice, the intervals between colonoscopies after polypectomy are variable, often a year long, and not based on data from randomized clinical trials. We sought to determine whether follow-up colonoscopy at three years would detect important colonic lesions as well as follow-up colonoscopy at both one and three years. Methods Patients were eligible if they had one or more adenomas, no previous polypectomy, and a complete colonoscopy and if all their polyps had been removed. They were randomly assigned to have follow-up colonoscopy at one and three years or at three years only. The two study end points were the detection of any adenoma, and the detection of adenomas with advanced pathological features (defined as those >1 cm in diameter and those with high-grade dysplasia or invasive cancer). Results Of 2632 eligible patients, 141...
933 citations