Yoshida Naohisa, Naito Yuji, Siah Kewin Tien Ho, Murakami Takaaki, Ogiso Kiyoshi, Hirose Ryohei, Inada Yutaka, Inoue Ken, Konishi Hideyuki, Kugai Munehiro, Morimoto Yasutaka, Hasegawa Daisuke, Kanemasa Kazuyuki, Wakabayashi Naoki, Yagi Nobuaki, Yanagisawa Akio, Itoh Yoshito
Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Singapore.
Division of Gastroenterology & Hepatology, University Medicine Cluster, National University Hospital, Singapore.
Dig Endosc. 2016 Mar;28(2):194-202. doi: 10.1111/den.12551. Epub 2015 Nov 16.
There are limited studies on incidence rates of metachronous neoplastic lesions after resecting large colorectal polyps. In the present study, we analyzed metachronous lesions after endoscopic resection of colorectal polyps ≥20 mm in size.
We retrospectively analyzed consecutive patients who underwent endoscopic resection of polyps from 2006 to 2013 at two affiliated hospitals. All patients underwent at least two total colonoscopies before follow up to ensure minimal missed polyps. Only patients who had follow-up colonoscopy annually after resection were recruited. We separated patients according to size of polyp resected; there were 239 patients in the ≥20-mm group and 330 patients in the <20-mm group. Clinical characteristics and cumulative rates of metachronous advanced adenoma and cancer in both groups were analyzed. Advanced adenoma was defined as a neoplastic lesion ≥10 mm in size and adenoma with a villous component.
Cumulative rate of development of metachronous advanced adenoma and cancer in the ≥20-mm group was significantly higher than in the <20-mm group (22.9% vs. 9.5%, P < 0.001) at 36 months. There was also more development of small polyps 5-9 mm in the ≥20-mm group than in the <20-mm group (45.2% vs. 28.8%, P < 0.001). With respect to metachronous lesions, there were more right-sided colonic lesions in the ≥20-mm group than in the <20-mm group (78.8% vs. 50.0%, P = 0.015).
High incidence rates of development of metachronous neoplastic lesions were detected after resection of colorectal polyps ≥20 mm in size.
关于大肠大息肉切除术后异时性肿瘤性病变的发病率研究有限。在本研究中，我们分析了大小≥20毫米的大肠息肉内镜切除术后的异时性病变。
我们回顾性分析了2006年至2013年在两家附属医院接受息肉内镜切除术的连续患者。所有患者在随访前至少接受了两次全结肠镜检查，以确保息肉漏诊率降至最低。仅纳入切除术后每年接受结肠镜随访的患者。我们根据切除息肉的大小对患者进行分组；≥20毫米组有239例患者，<20毫米组有330例患者。分析了两组的临床特征以及异时性高级别腺瘤和癌症的累积发生率。高级别腺瘤定义为大小≥10毫米的肿瘤性病变以及具有绒毛成分的腺瘤。
36个月时，≥20毫米组异时性高级别腺瘤和癌症的累积发生率显著高于<20毫米组（22.9%对9.5%，P<0.001）。≥20毫米组5-9毫米小息肉的发生也比<20毫米组更多（45.2%对28.8%，P<0.001）。关于异时性病变，≥20毫米组右侧结肠病变比<20毫米组更多（78.8%对50.0%，P=0.015）。
在切除大小≥20毫米的大肠息肉后，检测到异时性肿瘤性病变的高发病率。
