肠息肉切除术后异时性结直肠肿瘤风险评估：一项临床、内镜及病理研究

Evaluation of the risk for metachronous colorectal neoplasms following intestinal polypectomy: a clinical, endoscopic and pathological study.

作者信息

Fornasarig M, Valentini M, Poletti M, Carbone A, Bidoli E, Sozzi M, Cannizzaro R

机构信息

Dept. of Gastroenterology and Digestive Endoscopy, National Cancer Institute, IRCCS, Aviano (PN), Italy.

出版信息

Hepatogastroenterology. 1998 Sep-Oct;45(23):1565-72.

PMID:9840106

Abstract

BACKGROUND/AIMS: Surveillance programs are recommended for patients with previous intestinal polypectomy because of the high rate of adenomatous recurrences and risk of subsequent colorectal cancer. The parameters to identify patients at higher risk and the length and schedules of follow-up have not yet been established. We considered some clinical, endoscopic and pathological parameters in order to assess the probability of developing new colorectal neoplasms and eventually to schedule proper surveillance programs.

METHODOLOGY

Patients with removed adenomas were enrolled into a clinico-endoscopic follow-up, comprehensive of two colonoscopies the first at 1 year and the second at 3 years. We evaluated the risk of new neoplasms dividing the patients into four groups according to the number and size of the adenomas removed and the parameters considered.

RESULTS

Of 164 patients enrolled 156 completed the study. We had an overall 21.3% of adenomatous recurrences at 1 year and 12.8% at 3 years. Most of the adenomas removed were tubular and small in size (< 1 cm). The percentage of patients who had adenomas with advanced pathological features was 1.82% at 1 year and 0.64% at 3 years. The increase in number and size of the adenomas removed on the initial colonoscopic examination was the only one parameter statistically significant, X(2)1 (trend) 5.11; p<0.05 at the first follow-up and X(2)1 (trend) 4.87; p<0.05 at the second follow-up.

CONCLUSIONS

Patients with previous single adenoma showed few recurrences of extremely benign histological features. Since they do not require short-term endoscopic examination, it would be reasonable to defer the next colonoscopy for at least another 5 years. During follow-up, patients with multiple polyps had adenomas with advanced pathological features so it was useful to follow-up at 1 year. The tendency for advanced pathological features of removed polyps was not seen at 3 years, suggesting the importance of long-term follow-up, but with longer intervals.

摘要

背景/目的：由于腺瘤复发率高以及后续患结直肠癌的风险，建议对既往有肠道息肉切除术的患者进行监测。目前尚未确定用于识别高危患者的参数以及随访的时长和方案。我们考虑了一些临床、内镜和病理参数，以评估发生新的结直肠肿瘤的可能性，并最终制定合适的监测方案。

方法

将切除腺瘤的患者纳入临床内镜随访，包括在1年时进行首次结肠镜检查，在3年时进行第二次结肠镜检查。我们根据切除腺瘤的数量和大小以及所考虑的参数将患者分为四组，评估发生新肿瘤的风险。

结果

纳入的164例患者中有156例完成了研究。1年时腺瘤复发率总体为21.3%，3年时为12.8%。切除的大多数腺瘤为管状且体积较小（<1 cm）。具有高级别病理特征的腺瘤患者比例在1年时为1.82%，3年时为0.64%。初次结肠镜检查时切除腺瘤数量和大小的增加是唯一具有统计学意义的参数，第一次随访时X(2)1（趋势）=5.11；p<0.05，第二次随访时X(2)1（趋势）=4.87；p<0.05。