FEATURES OF ENDOSCOPIC SURVEILLANCE AFTER COLORECTAL CANCER SURGERY IN YOUNG PATIENTS

Aims:

To analyze the development of colorectal polyps detected during endoscopic surveillance after surgery in patients with early onset (< 45 years) colorectal cancer (EOCRC), in order to identify patients with greater risk of metachronic CRC

Methods:

A retrospective cohort of 121 patients with previous diagnosis of EOCRC was included. Data from 10 year follow-ups after surgery was collected and four subgroups were formed according to the moment of detection of polyps: Development of polyps within the first 5 years (group A), after 5 years (group B), at any time during the complete period of surveillance (group C) and no development of polyps (group D). The characteristics of each group were compared.

Results:

60% of patients developed polyps at some point in this period. 34,5% developed polyps within first 5 years, 7,5% after 5 years, 18,3% had polyps at some time during the complete period and 40% of the patients did not develop any. The number of polyps detected was higher in patients from group A (6,2 (CI 95% 3,18 – 9,36)) compared to group B (2,38 (CI 95% 1,74 – 3,01) and C (4,29 (CI 95% 2,04 – 6,53))

Among patients in group A, histology of polyps was mainly a combination of adenomatous and hyperplastic (76%). In group B histology was mainly adenomatous (45%) and in group C, mainly hyperplastic (57,1%). Hiperplastic histology was predominantly detected in patients with Lynch syndrome. Detection of polyps after 5 years was significantly associated to better survival and illness-free survival (p = 0,018)

Conclusions:

In our study most patients developed polyps within the first 5 years of follow-up, although other patients had different features. Differences between groups were found regarding histology of polyps and prognosis. Further studies are required to identify groups at greater risk of developing polyps and metachronic CRC.