Incomplete resection of colorectal polyps associated with neoplasia recurrence: Study

USA: Researchers have discovered a statistically substantially higher incidence of future neoplasia and advanced neoplasia in colon segments after partial resection compared to segments with complete resection. The findings of this study were published in the American College of Physicians, Annals of Internal Medicine on 10th August 2021.

Incomplete excision of neoplastic polyps is thought to be a major cause of colorectal cancer development. However, there is little information on the natural history of polyps that has been partially excised. To fill this knowledge gap, Heiko Pohl and the team conducted an observational cohort study between 2009 to 2012, with the objective of determining the risk of metachronous neoplasia during a surveillance colonoscopy following a reported partial polyp excision.

The proportion of colon segments with at least one neoplastic polyp at the initial surveillance examination was evaluated as segment metachronous neoplasia. Segment metachronous neoplasia was compared between segments that had a prior incomplete polyp resection (incomplete segments) and those that had a prior complete resection (full segments), taking into consideration segment clustering among individuals. Patients with a 5- to 20-mm malignant polyp excision, a documented complete or partial resection, and a surveillance examination were included.

In the original study, 166 of the 233 individuals received at least one surveillance assessment. After partial resection, the median time to surveillance was shorter than after full resection (median, 17 vs. 45 months). The probability of developing any metachronous neoplasia was higher in parts with partial resection vs full resection. Incomplete segments also had more neoplastic polyps and a higher likelihood of advanced neoplasia. The greatest independent factor linked with metachronous neoplasia was incomplete resection.

Reference:

Pohl, H., Anderson, J. C., Aguilera-Fish, A., Calderwood, A. H., Mackenzie, T. A., & Robertson, D. J. (2021). Recurrence of Colorectal Neoplastic Polyps After Incomplete Resection. Annals of Internal Medicine. https://doi.org/10.7326/m20-6689