Division of Gastroenterology, Department of Internal Medicine, Dankook University Hospital, Cheonan, Korea.
Korean J Intern Med. 2021 Mar;36(2):305-312. doi: 10.3904/kjim.2019.053. Epub 2020 Apr 21.
BACKGROUND/AIMS: Regular surveillance colonoscopy after colon cancer resection is recommended for detecting metachronous adenoma and cancer. However, risk factors for metachronous neoplasms have not been fully evaluated. We aimed to assess risk factors for advanced metachronous neoplasms during surveillance colonoscopy after colon cancer resection.
Patients who underwent curative colectomy for nonmetastatic colon cancer between January 2002 and December 2012 were evaluated and followed up to December 2017.
A total of 293 patients were enrolled in this study. Among these, 179 (61.1%) were male, and the mean age was 63.2 ± 10.4 years. On perioperative clearing colonoscopy, synchronous high-risk adenomas (number ≥ 3, size ≥ 10 mm, high-grade dysplasia, villous histology, and serrated adenoma ≥ 10 mm) were detected in 95 patients (32.4%), and they were significantly associated with male sex, old age (≥ 65 years), current alcohol consumption, and current smoking (p < 0.05). During the follow-up period (mean 74.4 ± 36.4 months), advanced metachronous neoplasms were found in 45 patients (15.4%), including metachronous cancer in four (1.4%). In multivariate analysis, distal colon cancer (distal-to-splenic flexure; odds ratio [OR], 4.402; 95% confidence interval [CI], 1.658 to 11.689; p = 0.003), synchronous highrisk adenomas (OR, 3.225; 95% CI, 1.503 to 6.918; p = 0.003), and hypertension (OR, 2.270; 95% CI, 1.058 to 4.874; p = 0.035) were significant risk factors for advanced metachronous neoplasms.
During surveillance after curative colon cancer resection, patients with distal colon cancer, synchronous high-risk adenomas, and hypertension may need meticulous follow-up to improve overall outcomes.
背景/目的：结直肠癌切除术后建议定期进行结肠镜检查以检测腺瘤和癌症的异时性。然而，尚未充分评估异时性肿瘤的危险因素。我们旨在评估结直肠癌切除术后结肠镜监测中晚期异时性肿瘤的危险因素。
评估并随访 2002 年 1 月至 2012 年 12 月期间接受非转移性结肠癌根治性切除术的患者。
本研究共纳入 293 例患者。其中，男性 179 例（61.1%），平均年龄为 63.2 ± 10.4 岁。在围手术期清除性结肠镜检查中，95 例（32.4%）患者发现同步高危腺瘤（数量≥3 个、大小≥10mm、高级别异型增生、绒毛状组织学和锯齿状腺瘤≥10mm），且这些腺瘤与男性、高龄（≥65 岁）、当前饮酒和当前吸烟显著相关（p<0.05）。在随访期间（平均 74.4 ± 36.4 个月），45 例患者（15.4%）发现晚期异时性肿瘤，其中包括 4 例（1.4%）异时性癌症。多因素分析显示，远端结肠癌（脾曲以下；比值比[OR]，4.402；95%置信区间[CI]，1.658 至 11.689；p=0.003）、同步高危腺瘤（OR，3.225；95%CI，1.503 至 6.918；p=0.003）和高血压（OR，2.270；95%CI，1.058 至 4.874；p=0.035）是晚期异时性肿瘤的显著危险因素。
在结直肠癌根治性切除术后的监测期间，患有远端结肠癌、同步高危腺瘤和高血压的患者可能需要细致的随访，以改善整体结局。
