Incomplete resection predicts recurrence of colorectal neoplastic polyps

Incomplete resection of colon segments is significantly associated with a higher risk for future neoplasia and advanced neoplasia than those with complete resection, a study has found.

The investigators conducted this observational cohort study in two academic medical centres involving patients who participated in the Complete Adenoma Resection study from 2009 to 2012. Those who had resection of a 5- to 20-mm neoplastic polyp, had a documented complete or incomplete resection, and had a surveillance examination were eligible.

Segment metachronous neoplasia, defined as the proportion of colon segments with at least one neoplastic polyp at first surveillance examination, was measured and compared between segments with a prior incomplete resection (incomplete segments) and those with a prior complete resection (complete segments), accounting for clustering segments within patients.

Of the 233 participants in the original study, 166 (71 percent) had at least one surveillance examination. Median time to surveillance was shorter after incomplete resection compared with complete resection (median, 17 vs 45 months).

Segments with incomplete resection showed a higher risk for any metachronous neoplasia than complete resection (52 percent vs 23 percent; risk difference [RD], 28 percent, 95 percent confidence interval [CI], 9–47; p=0.004). Incomplete segments also had a greater proportion of neoplastic polyps (mean, 0.8 vs 0.3; RD, 0.50, 95 percent CI, 0.1–0.9; p=0.008) and a higher risk for advanced neoplasia (18 percent vs 3 percent; RD, 15 percent, 95 percent CI, 1–29; p=0.034).

Overall, incomplete resection was the strongest independent predictor of metachronous neoplasia (odds ratio, 3.0, 95 percent CI, 1.12–8.17).

This study was limited by potential patient selection bias due to incomplete follow-up, according to the investigators.