Colorectal cancer risk after colonoscopic polypectomy: a population-based study and literature search

doi:10.1016/j.ejca.2004.11.007

European Journal of Cancer

Volume 41, Issue 3, February 2005, Pages 416-422

https://doi.org/10.1016/j.ejca.2004.11.007 Get rights and content

Abstract

Adenoma patients are considered to be at an elevated risk for colorectal cancer, even after their adenomas have been removed. The aim of this study was to estimate the colorectal cancer risk after colonoscopic polypectomy compared with age- and gender-matched general population controls. Colorectal cancer incidence was studied in 553 consecutive patients without cancer whose adenomas were colonoscopically removed in the endoscopy department of a general hospital. The colorectal cancer relative risk in these patients was 0.9 (0.3–2.0). A literature search was performed to identify all published studies on relative colorectal cancer risk after polypectomy. The relative risk estimates in seven other studies ranged from 0.2 (0.1–0.6) to 1.3 (0.6–2.3). The difference can, be explained partially by the inclusion or exclusion of patients with large sessile polyps and other factors. Our review shows that colorectal cancer risk after colonoscopic polypectomy does not exceed the risk in the general population.

Introduction

Colorectal cancer is a major cause of morbidity and mortality in developed countries. Approximately 334 000 new colorectal cancer cases were estimated in 1995 in Europe and the 5-year relative survival rate was approximately 45% [1]. It is generally believed that most cancers originate from adenomas. It is therefore recommended that patients with adenomas undergo a complete colonoscopy in order to remove all of these adenomas. However, adenomas may have been missed and new adenomas may develop rapidly. Therefore, colonoscopic surveillance is recommended in these patients. Surveillance should not be performed too frequently as colonoscopies are both risky and expensive. The surveillance interval is related to the average colorectal cancer risk after initial polypectomy. However, there is a wide variation in published relative colorectal cancer risk estimates compared with estimates for the general population. The aim of the present study was to estimate the risk in the initial years after the colonoscopic polypectomy compared with the age- and gender-matched general population. Data from a Dutch community hospital, and from a literature search were used. Surveillance was performed in most studies and the effect of surveillance on colorectal cancer risk is explored. We also studied whether differences in estimated risk are explained by differences in inclusion criteria.

Section snippets

Amsterdam study

Data for all 553 consecutive patients diagnosed with adenomas between 1988 and 1998 in the Slotervaart hospital, a general hospital in Amsterdam, the Netherlands, were collected. The patient’s date of birth, gender, and reason for the first visit were recorded. The date of the examination, examination method (colonoscopy, sigmoidoscopy, and barium enema), reach of the scope, and the result of the examination were noted at each colon examination. The date and results of the examinations recorded

Amsterdam study

Table 1 shows the characteristics of the 553 adenoma patients from the Slotervaart Hospital at the initial colon examination with polypectomy. The patients were regular referrals from the Amsterdam West sector with approximately 375 000 inhabitants. Mean age at the initial examination was 62.1 years. In most patients (77%), the reason for colonoscopy was not recorded. In the Netherlands, these are usually patients with symptoms who had a sigmoidoscopy and who were referred to colonoscopy due to

Discussion

Adenoma patients are considered to be at high risk for colorectal cancer, because adenomas are precursors of colorectal cancer. Therefore, once an adenoma is detected, colonoscopic polypectomy is performed and patients are regularly examined by colonoscopy. Meanwhile, the colorectal cancer risk in adenoma patients after removal of adenomas is not well known, and can only be measured by surveillance. The Amsterdam study shows a relative colorectal cancer risk after colonoscopic polypectomy of

Conflict of interest statement

None declared.

Acknowledgements

We thank N. de Vries for data entry, and E. Riemersma, T. Limarno, and L. van der Meer from the endoscopy department of Slotervaart Hospital in Amsterdam, and Dr. Westerga and G. Scholte from the Pathology Department of Slotervaart Hospital in Amsterdam for their assistance.

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Colorectal cancer risk after colonoscopic polypectomy: a population-based study and literature search

Abstract

Introduction

Section snippets

Amsterdam study

Amsterdam study

Discussion

Conflict of interest statement

Acknowledgements

Eur J Cancer

Gastroenterology Part 1 Suppl. 2

[Consensus follow-up study after polypectomy] Consensus follow-up-onderzoek na polipectomie

Ned Tijdschr Geneeskd

Prevention of colorectal cancer by colonoscopic polypectomy

N Engl J Med

Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps

N Engl J Med