Relationship Between Colorectal Carcinoma and Adenoma Detection Rate by Colonoscopy

Document Type: Research/Original Article

Authors

1 Department of General and Digestive Surgery, Príncipe de Asturias University Hospital, Alcalá de Henares, Madrid, Spain

2 Surgery, Department of Medical and Social Sciences, Alcalá University, Alcalá de Henares, Spain

Abstract

Background: in recent years, colorectal cancer incidence has declined dramatically. Screening programs, based on endoscopic resection of polipoid precancerous lesions, are being fundamental in that desirable improvement.

Material and methods: prospective observational study of a set of patients who had an endoscopic resection of colonic polipoid lesions from January-2007 to December-2012. We analized “polyps rate” by colonoscopy, number of patients, follow-up time, and “relationship with later cancer appearance“.

Results: 841 patients (357 women, a 42’4%, and 484 men, a 57’65%) with a total of 7007 colorectal polyps and a medium follow-up of 66 +/- 21’84 months. During the following 12 patients were diagnosed of colorectal cancer, who had not had any statistical significant difference in “polyps rate per colonoscopy”, nor for the number of “advanced adenomas” (Z=0’11, p=0’91), nor for “total adenomatous polyps” (Z=1’84, p=0’07). Nevertheless, we could see that patients without colorectal cancer showed lower “polyps rate per colonoscopy” of advanced adenoma (Z=4’61, p <0’001) and raw number of polyps (Z=7’09, p <0’001).

Conclusions: when comparing rates by number of patients, number of colonoscopic explorations and follow-up time, the advanced adenoma rate was found to be higher in patients who later developed colorectal carcinoma.

Keywords


 
1.      Lee BI, Hong SP, Kim SE, Kim SH, Kim HS, Hong SN, et al. Korean guidelines for colorectal cancer screening and polyp detection. Clin Endosc. 2012;45(1):25-43.
2.      Lieberman DA, Rex DK, Winawer SJ, Giardiello FM, Johnson DA, Levin TR. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2012;143(3):844-57.
3.      Misra T, Lalor E, Fedorak RN. Endoscopic perforation rates at a Canadian university teaching hospital. Canadian Journal of Gastroenterology and Hepatology. 2004;18(4):221-6.
4. De la Portilla de Juan F, Reyes Díaz ML, Ramallo Solía I. Impact of the pandemic on surgical activity in colorectal cancer in Spain. Results of a national survey. Cir Esp. 2020 Sep 1:S0009-739X(20)30265-7.
 
5.      Juillerat P, Peytremann-Bridevaux I, Vader JP, Arditi C, Schussele Filliettaz S, Dubois RW, et al. Appropriateness of colonoscopy in Europe (EPAGE II). Presentation of methodology, general results, and analysis of complications. Endoscopy. 2009;41(3):240-6.
6.      Provenzale D, Jasperson K, Ahnen DJ, Aslanian H, Bray T, Cannon JA, et al. Colorectal Cancer Screening, Version 1.2015. J Natl Compr Canc Netw. 2015;13(8):959-68; quiz 68.
7.      Colquhoun P, Chen HC, Kim JI, Efron J, Weiss EG, Nogueras JJ, et al. High compliance rates observed for follow up colonoscopy post polypectomy are achievable outside of clinical trials: efficacy of polypectomy is not reduced by low compliance for follow up. Colorectal Dis. 2004;6(3):158-61.
8.      Wolff WI, Shinya H. Polypectomy via the fiberoptic colonoscope. Removal of neoplasms beyond reach of the sigmoidoscope. N Engl J Med. 1973;288(7):329-32.
9.      Morson B DI. Malignant epithelial tumours and polyps. In: B. C. Morson IMPD, D. W. Day, J. R. Jass, A. B. Price and G. T. Williams, editor. Gastrointestinal pathology. Third ed1990. p. 597–629.
10.  Pai RK, Bettington M, Srivastava A, Rosty C. An update on the morphology and molecular pathology of serrated colorectal polyps and associated carcinomas. Mod Pathol. 2019 Oct;32(10):1390-1415.
11.  He X, Hang D, Wu K, Nayor J, Drew DA, Giovannucci EL, Ogino S, Chan AT, Song M. Long-term Risk of Colorectal Cancer After Removal of Conventional Adenomas and Serrated Polyps. Gastroenterology. 2020 Mar;158(4):852-861.
12.  9.         Young Y, Terdiman JP. Endoscopic management of familial colonic neoplasia. Gastrointest Endosc Clin N Am. 2005;15(3):549-80, ix-x.
13. Nguyen LH, Goel A, Chung DC. Pathways of Colorectal Carcinogenesis. Gastroenterology. 2020 Jan;158(2):291-302.
14. Safayeva AK, Bayramov NY. The importance of colonoscopy in the treatment of colorectal polyps and colorectal cancer screening. Ann Ital Chir. 2019;90:311-317.
15.    Hardcastle JD, Thomas WM, Chamberlain J, Pye G, Sheffield J, James PD, et al. Randomised, controlled trial of faecal occult blood screening for colorectal cancer. Results for first 107,349 subjects. Lancet. 1989;1(8648):1160-4.
16.    Kronborg O, Fenger C, Worm J, Pedersen SA, Hem J, Bertelsen K, et al. Causes of death during the first 5 years of a randomized trial of mass screening for colorectal cancer with fecal occult blood test. Scand J Gastroenterol. 1992;27(1):47-52.
17.    Jang HW, Park SJ, Hong SP, Cheon JH, Kim WH, Kim TI. Risk Factors for Recurrent High-Risk Polyps after the Removal of High-Risk Polyps at Initial Colonoscopy. Yonsei Med J. 2015;56(6):1559-65.
18.    Stryker SJ, Wolff BG, Culp CE, Libbe SD, Ilstrup DM, MacCarty RL. Natural history of untreated colonic polyps. Gastroenterology. 1987;93(5):1009-13.
19.    Couso LM, Lubrano P, Castelluccio S, Coghlan E, Topor J, Peters R, et al. [Endoscopic polypectomy of colorectal adenomas: Monitoring patients in order to review the colonoscopic surveillance interval]. Acta Gastroenterol Latinoam. 2014;44(3):216-22.
20.    Wang Y, Zhang FC, Wang YJ. The efficacy and safety of non-steroidal anti-inflammatory drugs in preventing the recurrence of colorectal adenoma: a meta-analysis and systematic review of randomized trials. Colorectal Dis. 2015;17(3):188-96.
21.    O'Brien MJ, Winawer SJ, Zauber AG, Gottlieb LS, Sternberg SS, Diaz B, et al. The National Polyp Study. Patient and polyp characteristics associated with high-grade dysplasia in colorectal adenomas. Gastroenterology. 1990;98(2):371-9.
22.    Loeve F, Boer R, Zauber AG, Van Ballegooijen M, Van Oortmarssen GJ, Winawer SJ, et al. National Polyp Study data: evidence for regression of adenomas. Int J Cancer. 2004;111(4):633-9.
23.    Winawer SJ, Zauber AG, Ho MN, O'Brien MJ, Gottlieb LS, Sternberg SS, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med. 1993;329(27):1977-81.
24.    Winawer SJ, Zauber AG, O'Brien MJ, Gottlieb LS, Sternberg SS, Stewart ET, et al. The National Polyp Study. Design, methods, and characteristics of patients with newly diagnosed polyps. The National Polyp Study Workgroup. Cancer. 1992;70(5 Suppl):1236-45.
25.    Barreda Costa C, Vila Gutierrez S, Salazar Cabrera F, Barriga Calle E, Velarde Criado H, Barriga Briceno J. [Advanced adenoma in 3700 colonoscopies]. Rev Gastroenterol Peru. 2010;30(2):113-20.
26.    Davila RE, Rajan E, Baron TH, Adler DG, Egan JV, Faigel DO, et al. ASGE guideline: colorectal cancer screening and surveillance. Gastrointest Endosc. 2006;63(4):546-57.
27.    Hassan C, Quintero E, Dumonceau J, Regula J, Brandão C, Chaussade S, et al. European Society of Gastrointestinal Endoscopy. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2013;45(10):842-51.
28.    Morson BC, Whiteway JE, Jones EA, Macrae FA, Williams CB. Histopathology and prognosis of malignant colorectal polyps treated by endoscopic polypectomy. Gut. 1984;25(5):437-44.
29.    Winawer SJ, O'Brien MJ, Waye JD, Kronborg O, Bond J, Fruhmorgen P, et al. Risk and surveillance of individuals with colorectal polyps. Who Collaborating Centre for the Prevention of Colorectal Cancer. Bull World Health Organ. 1990;68(6):789-95.
30. Heisser T, Peng L, Weigl K, Hoffmeister M, Brenner H. Outcomes at follow-up of negative colonoscopy in average risk population: systematic review and meta-analysis. BMJ. 2019 Nov 13;367:l6109.
31.    Jung ST, Sohn DK, Hong CW, Kim BC, Park JW, Han KS, et al. Importance of early follow-up colonoscopy in patients at high risk for colorectal polyps. Annals of coloproctology. 2013;29(6):243-7.
32.    Ratuapli SK, Gurudu SR, Atia MA, Crowell MD, Umar SB, Harrison ME, et al. Postcolonoscopy followup recommendations: comparison with and without use of polyp pathology. Diagnostic and therapeutic endoscopy. 2014;2014.
33. Mangas-Sanjuan C, Jover R, Cubiella J, Marzo-Castillejo M, Balaguer F, Bessa X, Bujanda L, Bustamante M, Castells A, Diaz-Tasende J, Díez-Redondo P, Herráiz M, Mascort-Roca JJ, Pellisé M, Quintero E; Grupo de Cribado del Cáncer Colorrectal de la Sociedad Española de Epidemiología. Endoscopic surveillance after colonic polyps and colorrectal cancer resection. 2018 update. Gastroenterol Hepatol. 2019 Mar;42(3):188-201.
34. Wolf AMD, Fontham ETH, Church TR, Flowers CR, Guerra CE, LaMonte SJ, Etzioni R, McKenna MT, Oeffinger KC, Shih YT, Walter LC, Andrews KS, Brawley OW, Brooks D, Fedewa SA, Manassaram-Baptiste D, Siegel RL, Wender RC, Smith RA. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin. 2018 Jul;68(4):250-281.