Loffeld Ruud J L F, Liberov Boris, Dekkers Pascale E P
Department of Internal Medicine and Gastroenterology, Zaans Medisch Centrum, Zaandam, The Netherlands.
J Gastrointest Oncol. 2018 Aug;9(4):674-678. doi: 10.21037/jgo.2018.05.02.
Years ago, it was established that removal of adenomas will lead to a lower incidence of colorectal cancer. This study aims to establish the occurrence of colorectal cancer in unselected patients after index colonoscopy with polyp removal.
A prospectively collected dataset on colonoscopy covering 25 consecutive years was used. Patients in who during the index (first) procedure a polyp(s) was removed were included. Excluded were patients with colorectal cancer and patients belonging to Lynch families. In case of cancer time after the index and previous procedure, tumor stage, histology of earlier removed polyps, localization of the tumor and demographics were noted.
In 1,617 patients polyp(s) were removed. Thirty (1.9%) patients developed colorectal cancer. In 18 cases adenomas were removed during prior endoscopies. Five patients only had hyperplastic polyp(s). Nine patients with cancer already were older than 75 years when the previous endoscopy was done. Patients with adenomas prior to the cancer were older compared with patients with hyperplastic polyps [mean (SD): 71.6 (5.8) versus 64.2 (10.5) years, P=0.046]. The majority of cancers were located in the proximal colon (75%). The time between diagnosing cancer and the previous colonoscopy was mean 70.6 months with a median of 60.0 months (range, 12.0-167.0 months).
It is concluded that follow-up after removal of polyps in normal daily practice is associated with a low incidence of developing colorectal cancer.
多年前就已证实，切除腺瘤可降低结直肠癌的发病率。本研究旨在确定在未经过筛选的患者中，在首次结肠镜检查切除息肉后结直肠癌的发生情况。
使用前瞻性收集的连续25年的结肠镜检查数据集。纳入在首次（索引）检查中切除息肉的患者。排除患有结直肠癌的患者和林奇综合征家族的患者。如果发生癌症，则记录索引检查和先前检查后的时间、肿瘤分期、先前切除息肉的组织学类型、肿瘤位置和人口统计学信息。
1617例患者切除了息肉。30例（1.9%）患者发生了结直肠癌。18例患者在先前的内镜检查中切除了腺瘤。5例患者仅患有增生性息肉。9例癌症患者在先前进行内镜检查时年龄已超过75岁。癌症患者中先前有腺瘤的患者比有增生性息肉的患者年龄更大[平均（标准差）：71.6（5.8）岁对64.2（10.5）岁，P = 0.046]。大多数癌症位于近端结肠（75%）。诊断癌症与先前结肠镜检查之间的时间平均为70.6个月，中位数为60.0个月（范围，12.0 - 167.0个月）。
得出的结论是，在日常实践中息肉切除后的随访与结直肠癌的低发病率相关。
