Aims:
To evaluate risk factors and clinical significance for recurrence after endoscopic mucosal resection (EMR) of colorectal adenomas > 20 mm after a 5-year follow-up.
Methods:
Prospective cohort study of patients submitted to colorectal EMR from June 2008 to November 2012 at our department, with subsequent 5-year follow-up. Lesions removed by piecemeal technique after submucosal injection. Recorded demographic data, lesion characteristics, complications of the procedure and recurrence at 3, 12, 36 and 60 months. Possible factors associated with local recurrence analyzed by logistic regression.
Results:
Excised 104 lesions in 98 consecutive patients (59% male, mean age 69 ± 10 years). Median polyp size was 30 mm (IQR 15 – 45); 69% sessile. Anorectal junction location in 15,4% (n = 16). Histology showed superficial carcinoma or high-grade intraepithelial neoplasia in 53% (n = 55). The follow-up was complete in 85/98 (86,7%) patients. Nine patients died during follow-up of unrelated causes. Histologically proven recurrence was observed in 23% (23/100) at 3 months, 10% (9/90) at 12 months and 3.4% at 36 months. No recurrence at 60 months (0/85). Recurrence was treated endoscopically with success in 100% of cases. Surgery was needed in one patient (1%) due to non-curative excision. There were 12 complications (11.5%), all solved without surgery: 10 bleeding (2 immediate and 8 late), 1 perforation (0.9%) and 1 post-polypectomy syndrome.
On multivariable analysis, significant risk factors for recurrence were cecal lesions (OR 7, 95% CI: 1.5 – 33.5) and anorectal junction location (OR 6.4, CI 95%: 1.4 – 29.7). In our series, size ≥40 mm (OR 1.2, 95% CI: 0.3 – 4.4) and use of argon plasma coagulation (OR 2.4, 95% CI: 0.6 – 9.5) were not significant.
Conclusions:
Meticulous endoscopic follow-up is warranted after endoscopic mucosal resection of adenomas, particularly in complex lesion sites but recurrence was endoscopically managed in all cases, not representing a significant clinical problem. A 5-year follow-up proved the safety and long-term efficacy of the technique.
