Colorectal cancers soon after colonoscopy: A pooled multicohort analysis

Douglas J. Robertson, David A. Lieberman, Sidney J. Winawer, Dennis J. Ahnen, John A. Baron, Arthur Schatzkin, Amanda J. Cross, Ann G. Zauber, Timothy R. Church, Peter Lance, E. Robert Greenberg, María Elena Martínez

Research output: Contribution to journalArticlepeer-review

221 Scopus citations

Abstract

Objective: Some individuals are diagnosed with colorectal cancer (CRC) despite recent colonoscopy. We examined individuals under colonoscopic surveillance for colonic adenomas to assess possible reasons for diagnosing cancer after a recent colonoscopy with complete removal of any identified polyps. Design: Primary data were pooled from eight large (>800 patients) North American studies in which participants with adenoma(s) had a baseline colonoscopy (with intent to remove all visualised lesions) and were followed with subsequent colonoscopy. We used an algorithm based on the time from previous colonoscopy and the presence, size and histology of adenomas detected at prior exam to assign interval cancers as likely being new, missed, incompletely resected (while previously an adenoma) or due to failed biopsy detection. Results: 9167 participants (mean age 62) were included in the analyses, with a median follow-up of 47.2 months. Invasive cancer was diagnosed in 58 patients (0.6%) during follow-up (1.71 per 1000 person-years follow-up). Most cancers (78%) were early stage (I or II); however, 9 (16%) resulted in death from CRC. We classi fied 30 cancers (52%) as probable missed lesions, 11 (19%) as possibly related to incomplete resection of an earlier, non-invasive lesion and 14 (24%) as probable new lesions. The cancer diagnosis may have been delayed in three cases (5%) because of failed biopsy detection. Conclusions: Despite recent colonoscopy with intent to remove all neoplasia, CRC will occasionally be diagnosed. These cancers primarily seem to represent lesions that were missed or incompletely removed at the prior colonoscopy and might be avoided by increased emphasis on identifying and completely removing all neoplastic lesions at colonoscopy.

Original languageEnglish (US)
Pages (from-to)949-956
Number of pages8
JournalGut
Volume63
Issue number6
DOIs
StatePublished - Jun 1 2014

ASJC Scopus subject areas

  • Gastroenterology

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