Borda Martín Ana, Martínez-Peñuela José M, Muñoz-Navas Miguel, Borda Celaya Fernando, Jiménez Pérez Javier, Carretero Ribón Cristina
Servicio Digestivo, Hospital de Navarra, Pamplona, España.
Gastroenterol Hepatol. 2010 Jun-Jul;33(6):419-24. doi: 10.1016/j.gastrohep.2010.01.006. Epub 2010 Apr 5.
To study the possibility of shift toward more proximal sites in colorectal cancer (CRC) after resection of tumors and synchronous lesions.
We reviewed 382 resected CRC diagnosed and followed-up with complete colonoscopies. The localization of metachronous adenomas was compared with that of synchronous lesions overall and by sex, tumoral size and the number of synchronous lesions. The frequency of exclusively proximal localization in first-, second- and third-generation metachronous adenomas was compared with that of synchronous adenomas.
A total of 54.5% of patients with CRC had synchronous adenomas. After a median follow-up of 48 months, with 2.74+/-1.47 colonoscopies/case, 42.4% developed metachronous adenomas, 16.8% second-generation adenomas and 7.3% third-generation lesions. Proximal shift was found in metachronous adenomas in both sexes, independently of tumoral size and the number of initial lesions. The frequency of exclusively proximal localization in adenomas was 21.2% in synchronous lesions, 39.5% in first-generation metachronous adenomas (p=0.0001; OR=2.46 [1.50-3.95]), 42.6% in second-generation metachronous adenomas (p=0.0008; OR=2.77 [1.44-5.31]) and 39.3% in third-generation metachronous lesions (p=0.0003; OR=2.41 [0.97-5.93]).
We found a high incidence of synchronous and metachronous adenomas. Metachronous adenomas showed a proximal shift, independently of sex, tumoral size and the number of synchronous lesions. This tendency was maintained in successive generations of metachronous adenomas, thus demonstrating the need to perform complete colonoscopies throughout the postoperative follow-up period.
研究结直肠癌（CRC）肿瘤及同步病变切除后向更近端部位转移的可能性。
我们回顾了382例经完整结肠镜检查诊断并随访的切除性CRC病例。将异时性腺瘤的定位与同步病变的总体定位进行比较，并按性别、肿瘤大小和同步病变数量进行比较。比较第一代、第二代和第三代异时性腺瘤中仅近端定位的频率与同步腺瘤的频率。
共有54.5%的CRC患者有同步腺瘤。中位随访48个月，每例患者平均接受2.74±1.47次结肠镜检查，42.4%的患者出现异时性腺瘤，16.8%为第二代腺瘤，7.3%为第三代病变。在男女异时性腺瘤中均发现近端转移，与肿瘤大小和初始病变数量无关。腺瘤仅近端定位的频率在同步病变中为21.2%，第一代异时性腺瘤中为39.5%（p = 0.0001；OR = 2.46 [1.50 - 3.95]），第二代异时性腺瘤中为42.6%（p = 0.0008；OR = 2.77 [1.44 - 5.31]），第三代异时性病变中为39.3%（p = 0.0003；OR = 2.41 [0.97 - 5.93]）。
我们发现同步和异时性腺瘤的发生率很高。异时性腺瘤出现近端转移，与性别、肿瘤大小和同步病变数量无关。这种趋势在连续几代异时性腺瘤中持续存在，因此表明在术后随访期间需要进行完整的结肠镜检查。
