Fuccio Lorenzo, Spada Cristiano, Frazzoni Leonardo, Paggi Silvia, Vitale Giovanna, Laterza Liboria, Mussetto Alessandro, Rojas Fabiola, Radaelli Franco, Hassan Cesare, Petruzziello Lucio, Frazzoni Marzio
Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Digestive Endoscopy Unit, Catholic University, Rome, Italy.
Gastrointest Endosc. 2015 Aug;82(2):337-43. doi: 10.1016/j.gie.2014.12.057. Epub 2015 Mar 29.
Patients with history of colonic resection for cancer have an increased risk of the development of metachronous malignant and premalignant lesions. Scanty data are reported on detection rates of premalignant lesions during colonoscopy surveillance in this setting.
To assess the risk of metachronous precancerous lesions developing in patients with previous colonic surgery for cancer according to the resection type.
Retrospective study.
Two academic centers in Italy.
A total of 441 patients; 256 with previous left-sided colectomy (LCR) (LCR group) and 185 with previous right-sided colectomy (RCR) (RCR group).
Second surveillance colonoscopy.
Polyp and adenoma detection rates.
At least 1 adenoma was diagnosed in 76 of 256 patients (30% adenoma detection rate) and in 35 of 185 patients (19% adenoma detection rate) in the LCR and RCR groups, respectively (P=.014), yielding an odds ratio of 1.83 (95% confidence interval, 1.16-2.89). Corresponding figures for the polyp detection rate were 39% and 25%, respectively (P=.002; odds ratio 1.97; 95% confidence interval, 1.30-3.00).
Retrospective study with colonoscopy baseline information missing.
Patients who have undergone LCR are at higher risk of the development of adenomas than those who have undergone RCR. If this result is confirmed by large prospective studies, surveillance programs could be targeted according to the type of colonic resection, with longer intervals for patients with previous RCR compared with LCR.
有结肠癌结肠切除术病史的患者发生异时性恶性和癌前病变的风险增加。关于在此情况下结肠镜监测期间癌前病变的检出率，报道的数据较少。
根据切除类型评估既往因癌症接受结肠手术的患者发生异时性癌前病变的风险。
回顾性研究。
意大利的两个学术中心。
共441例患者；256例既往接受左侧结肠切除术（LCR）（LCR组），185例既往接受右侧结肠切除术（RCR）（RCR组）。
第二次监测结肠镜检查。
息肉和腺瘤检出率。
LCR组256例患者中有76例（腺瘤检出率30%）、RCR组185例患者中有35例（腺瘤检出率19%）至少诊断出1个腺瘤（P = 0.014），优势比为1.83（95%置信区间，1.16 - 2.89）。息肉检出率的相应数字分别为39%和25%（P = 0.002；优势比1.97；95%置信区间，1.30 - 3.00）。
回顾性研究，缺少结肠镜检查基线信息。
接受LCR的患者发生腺瘤的风险高于接受RCR的患者。如果这一结果得到大型前瞻性研究的证实，监测方案可根据结肠切除类型进行针对性调整，既往接受RCR的患者与接受LCR的患者相比，监测间隔时间可更长。
