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Original research
Risk of colorectal neoplasia after removal of conventional adenomas and serrated polyps: a comprehensive evaluation of risk factors and surveillance use
  1. Georgios Polychronidis1,2,3,
  2. Ming-Ming He1,4,
  3. Mathew Vithayathil1,5,
  4. Markus D Knudsen1,6,7,
  5. Kai Wang1,
  6. Mingyang Song1
  1. 1Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
  2. 2Department of General,Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
  3. 3Study Centre of the German Surgical Society, German Surgical Society/Heidelberg University Hospital, Heidelberg, Germany
  4. 4State Key Laboratory of Oncology in South China, Department of Medical Oncology, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
  5. 5Imperial College Healthcare NHS Trust, London, UK
  6. 6Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
  7. 7Department of Transplantation Medicine, Division of Surgery,Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
  1. Correspondence to Dr Mingyang Song, Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA; mis911{at}mail.harvard.edu

Abstract

Background Surveillance colonoscopy after polyp removal is recommended to prevent subsequent colorectal cancer (CRC). It is known that advanced adenomas have a substantially higher risk than non-advanced ones, but optimal intervals for surveillance remain unclear.

Design We prospectively followed 156 699 participants who had undergone a colonoscopy from 2007 to 2017 in a large integrated healthcare system. Using multivariable Cox proportional hazards regression we estimated the subsequent risk of CRC and high-risk polyps, respectively, according to index colonoscopy polyps, colonoscopy quality measures, patient characteristics and the use of surveillance colonoscopy.

Results After a median follow-up of 5.3 years, we documented 309 CRC and 3053 high-risk polyp cases. Compared with participants with no polyps at index colonoscopy, those with high-risk adenomas and high-risk serrated polyps had a consistently higher risk of CRC during follow-up, with the highest risk observed at 3 years after polypectomy (multivariable HR 5.44 (95% CI 3.56 to 8.29) and 8.35 (95% CI 4.20 to 16.59), respectively). Recurrence of high-risk polyps showed a similar risk distribution. The use of surveillance colonoscopy was associated with lower risk of CRC, with an HR of 0.61 (95% CI 0.39 to 0.98) among patients with high-risk polyps and 0.57 (95% CI 0.35 to 0.92) among low-risk polyps. Among 1548 patients who had high-risk polyps at both index and surveillance colonoscopies, 65% had their index polyps in the proximal colon and 30% had index and interval polyps in the same segments.

Conclusion Patients with high-risk polyp findings were at higher risk of subsequent CRC and high-risk polyps and may benefit from early surveillance within 3 years. The subsite distribution of the index and recurrent high-risk polyps suggests the contribution of incomplete resection and missed lesions to the development of interval neoplasia.

  • colorectal cancer
  • surveillance
  • colonic polyps
  • colonoscopy

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/gutjnl-2023-331729

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • X @MingyangSong3

    • Contributors GP: study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, statistical analysis, obtained funding. M-MH: analysis and interpretation of data, drafting of the manuscript, statistical analysis. MV: technical support, analysis and interpretation of data, drafting of the manuscript, statistical analysis. MDK: technical support, critical revision of the manuscript for important intellectual content. KW: acquisition of data, material support, critical revision of the manuscript for important intellectual content. MS: guarantor, study concept and design, statistical analysis, critical revision of the manuscript for important intellectual content, technical and material support, study supervision, obtained funding.

    • Funding German Research Foundation (Deutsche Forschungsgemeinschaft (DFG)—Project No 426308975 to GP).

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.