Open AccessRisk of post‐colonoscopy colorectal cancer due to incomplete adenoma resection: A nationwide, population‐based cohort study
Author(s) -
Belderbos Tim DG,
Pullens Hendrikus JM,
Leenders Max,
Schipper Marguerite EI,
Siersema Peter D,
Oijen Martijn GH
Publication year - 2017
Publication title -
ueg journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.667
H-Index - 35
eISSN - 2050-6414
pISSN - 2050-6406
DOI - 10.1177/2050640616662428
Subject(s) - medicine , colonoscopy , hazard ratio , adenoma , colorectal cancer , colorectal adenoma , gastroenterology , population , incidence (geometry) , cohort , dysplasia , chromoendoscopy , proportional hazards model , confidence interval , cancer , physics , environmental health , optics
Background Most post‐colonoscopy colorectal cancers (PC‐CRCs) are thought to develop from missed or incompletely resected adenomas. Aims We aimed to assess the incidence rate of PC‐CRC overall and per colorectal segment, as a proxy for PC‐CRC due to incomplete adenoma resection, and to identify adenoma characteristics associated with these PC‐CRCs. Methods We performed a nationwide, population‐based cohort study, including all patients with a first colorectal adenoma between 2000–2010 in the Dutch Pathology Registry (PALGA). Outcomes were the incidence rate of PC‐CRC overall and of PC‐CRC in the same colorectal segment, occurring between six months and five years after adenoma resection. A multivariable Cox proportional hazard analysis was performed to identify factors associated with PC‐CRCs in the same segment. Results We included 107,744 patients (mean age 63.4 years; 53.6% male). PC‐CRC was detected in 1031 patients (0.96%) with an incidence rate of 1.88 per 1000 person years. PC‐CRC in the same segment was found in 323 of 133,519 adenomas (0.24%) with an incidence rate of 0.56 per 1000 years of follow‐up. High‐grade dysplasia (hazard ratio (HR) 2.54, 95% confidence interval (CI) 1.99–3.25) and both villous (HR 2.63, 95% CI 1.79–3.87) and tubulovillous histology (HR 1.80, 95% CI 1.43–2.27) were risk factors for PC‐CRC in the same segment. Conclusions Approximately one‐third of PC‐CRCs are found in the same colorectal segment after adenoma resection and could therefore be a consequence of incomplete adenoma resection, occurring in one in 400 adenomas. The risk of PC‐CRC in the same segment is increased in adenomas with high‐grade dysplasia or (tubulo)villous histology.