Department of Gastroenterology, JCHO Kyoto Kuramaguchi Medical Center, Kyoto, Japan.
Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
Surg Endosc. 2020 Jul;34(7):2918-2925. doi: 10.1007/s00464-019-07072-7. Epub 2019 Sep 3.
Local recurrence after cold snare polypectomy (CSP) of colorectal polyps has not been well analyzed. In this study, we analyzed the characteristics of local recurrence.
We retrospectively reviewed consecutive lesions resected by CSP from 2014 to 2016 and lesions that were followed up at ≥ 10 months after CSP, were analyzed. Our indication for CSP was a benign tumor of < 15 mm in size. We analyzed local recurrence and its risk factors using multivariate analyses. In addition, we compared lesions of ≥ 10 mm and < 10 mm. Moreover, therapeutic methods for recurrence were analyzed.
Finally, we analyzed 554 cases out of 820 consecutive cases. The mean polyp size was 5.3 ± 2.8 mm and the en bloc resection and histopathological complete resection rates were 99.3% and 70.2%, respectively. The overall recurrence rate was 1.9% (mean follow-up period: 13.0 ± 4.0 months). Significant differences were observed between 11 recurrent lesions and 543 lesions without recurrence regarding polyp size (8.0 ± 3.7 mm vs. 5.2 ± 2.7 mm, p < 0.001), rate of sessile-serrated polyp (27.3% vs. 3.0%, p < 0.001), and histopathological positive margin (45.4% vs. 3.7%, p = 0.019). Multivariate analyses showed that a histopathological positive margin was the only significant risk factor for local recurrence (OR 16.600, 95% CI 3.707-74.331, p < 0.001). Regarding the comparison between 74 lesions of ≥ 10 mm and 480 lesions of < 10 mm, significant differences were observed in the en bloc resection rate (93.2% vs. 100%, p < 0.001), high-grade dysplasia rate (8.1% vs. 0.8%, p < 0.001), and histopathological complete resection rate (54.0% vs. 72.7%, p = 0.001). The recurrence rates of these two groups were 5.4% and 1.4%, respectively (p = 0.069). All recurrent cases could be resected with repeat CSP.
The local recurrence rate after CSP for lesions of < 10 mm was 1.4%. CSP was not recommended for lesions of ≥ 10 mm due to high rates of recurrence and malignancy.
冷圈套息肉切除术（CSP）后局部复发的情况尚未得到充分分析。本研究旨在分析局部复发的特征。
我们回顾性分析了 2014 年至 2016 年间连续接受 CSP 切除的病变，并对 CSP 后随访时间≥10 个月的病变进行了分析。我们采用 CSP 的适应证为大小<15mm 的良性肿瘤。我们使用多变量分析来分析局部复发及其危险因素。此外，我们比较了≥10mm 和<10mm 的病变。此外，还分析了复发的治疗方法。
最终，我们分析了连续 820 例病例中的 554 例。平均息肉大小为 5.3±2.8mm，整块切除和组织学完全切除率分别为 99.3%和 70.2%。总的复发率为 1.9%（平均随访时间：13.0±4.0 个月）。11 例复发病变与 543 例无复发病变在息肉大小（8.0±3.7mm 比 5.2±2.7mm，p<0.001）、无蒂锯齿状息肉比例（27.3%比 3.0%，p<0.001）和组织学阳性切缘（45.4%比 3.7%，p=0.019）方面存在显著差异。多变量分析显示，组织学阳性切缘是局部复发的唯一显著危险因素（OR 16.600，95%CI 3.707-74.331，p<0.001）。对于≥10mm 的 74 个病变和<10mm 的 480 个病变的比较，在整块切除率（93.2%比 100%，p<0.001）、高级别异型增生率（8.1%比 0.8%，p<0.001）和组织学完全切除率（54.0%比 72.7%，p=0.001）方面存在显著差异。两组的复发率分别为 5.4%和 1.4%（p=0.069）。所有复发病例均通过重复 CSP 切除。
<10mm 病变的 CSP 后局部复发率为 1.4%。由于复发率和恶性率较高，不建议对≥10mm 的病变进行 CSP。
