Incomplete polyp resection increases risk of future and advanced neoplasia

1. Incomplete resection of colon segments was shown to significantly increase the risk of future neoplasia compared to segments with complete resection.

2. Advanced neoplasia was shown to be more likely in incomplete segment resections compared to complete resections.

Evidence Rating Level: 2 (Good)

Study Rundown: An estimated account of incomplete polyp resection occurs for 10% to 30% of all post-colonoscopy colorectal cancer (CRC). However, only indirect evidence is available between incomplete polyp resection and CRC after colonoscopy. As such, this study compared the rate of neoplasia in segments with prior incomplete resection compared to the rate of neoplasia in segments with prior complete resection. Incomplete resection was defined as the presence of neoplastic tissue in any marginal biopsies. The study determined incomplete polyp resection significantly increased the risk of future neoplasia and advanced neoplasia compared to colon segments with complete resection. The observational cohort study was limited by potential patient bias due to incomplete patient follow-up. Nonetheless, this study’s results are significant, and its findings highlight the importance of polypectomy technique to ensure complete resection thereby reducing the risk of future neoplasia.

Click to read the study in Annals of Internal Medicine

Relevant Reading: Rates of incomplete resection of 1- to 20-mm colorectal polyps: a systematic review and meta-analysis

In-Depth [prospective cohort]: This observational cohort study enrolled 233 participants across two academic medical centers in the United States. Participants included in the study had resection of a 5- to 20-mm neoplastic polyp, documentation of complete or incomplete resection, and had a surveillance exam. Participants without appropriate documentation or a surveillance exam were excluded from this study. Incomplete resection was defined as the presence of neoplastic tissue in any marginal biopsies. Participants with documented incomplete resection were recommended for a surveillance exam within one year, while participants with a documented complete resection were provided surveillance recommendations based on current guidelines. The primary outcome was the proportion of segments with neoplasia at first surveillance colonoscopy. Of the 233 participants, 166 (71%) participants had at least one surveillance exam by the end of the study. Overall, the median time to surveillance was shorter in the incomplete resection group (median, 17 months; interquartile range, 12 to 47 months) compared to the complete resection group (median, 45 months; interquartile range, 35 to 62 months). In regard to the primary outcome, the risk for neoplasia was significantly greater in the incomplete (52%) group compared to the complete (23%) group (risk difference [RD], 28%; 95% confidence interval [CI], 9% to 47&; P = 0.004). Additionally, participants in the incomplete (18%) group were more likely to have advanced neoplasia compared to the complete (3%) group (RD, 15%; 95% CI, 1% to 29%; P = 0.034). Finally, an incomplete polyp resection was the strongest independent factor associated with neoplasia (odds ratio, 3.0; 95% CI, 1.12 to 8.17). Taken together, incomplete polyp resection was associated with an increased risk of future neoplasia and advanced neoplasia compared to complete resection.

Image: PD

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