Left-Sided Colectomy: One of the Important Risk Factors of Metachronous Colorectal Adenoma After Colectomy for Colon Cancer

Yun, Gee Young; Moon, Hee Seok; Kwon, In Sun; Kim, Ju Seok; Kang, Sun Hyung; Lee, Eaum Seok; Kim, Seok Hyun; Sung, Jae Kyu; Lee, Byung Seok

doi:10.1007/s10620-018-4958-y

Cited by 10 publications

(16 citation statements)

References 24 publications

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“…Considering this, we excluded patients with rectal cancer and only patients with colon cancer above the rectosigmoid junction were included in the present study. Even after excluding patients with rectal cancer, distal colon cancer remains an independent risk factor for metachronous colon neoplasms, which was consistent with findings in previous studies [12,13,17,21].…”

Section: Discussionsupporting

confidence: 92%

“…In this present study, the incidence of metachronous adenomas (63.8%) is higher than that in previous reports (25% to 48%) [9][10][11]. One possible explanation is the relatively longer follow-up period (mean 74 months) and large number of surveillance colonoscopies (median, 4) than those in previous studies [11][12][13]. The incidence of metachronous cancer (1.3%) is comparable in previous reports (0.6% to 9.0%) The Korean Journal of Internal Medicine.…”

Section: Discussioncontrasting

confidence: 78%

“…Tumor location is considered an important risk factor for metachronous neoplasms. In previous studies, distal colon cancer (left-sided colon cancer) was associated with a higher risk of metachronous neoplasm than proximal colon cancer (right-sided colon cancer) [12,13,17,18]. One possible explanation for this association is that interval colon neoplasm is more common in the proximal colon than in the distal colon.…”

Section: Discussionmentioning

confidence: 92%

“…According to the present study, hypertension was a significant risk factor for advanced metachronous neoplasms. Yun et al [12] reported that male sex, obesity, distal colon cancer, and hypertension were risk factors for metachronous adenomas after colectomy. Lin et al [23] reported that hypertension combined with smoking, elevated liver function test, or multiple adenomas were risk factors of metachronous colorectal adenomas after polypectomy.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors of advanced metachronous neoplasms in surveillance after colon cancer resection

Nam

Shin

2021

Korean J Intern Med

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Background/Aims: Regular surveillance colonoscopy after colon cancer resection is recommended for detecting metachronous adenoma and cancer. However, risk factors for metachronous neoplasms have not been fully evaluated. We aimed to assess risk factors for advanced metachronous neoplasms during surveillance colonoscopy after colon cancer resection. Methods: Patients who underwent curative colectomy for nonmetastatic colon cancer between January 2002 and December 2012 were evaluated and followed up to December 2017. Results: A total of 293 patients were enrolled in this study. Among these, 179 (61.1%) were male, and the mean age was 63.2 ± 10.4 years. On perioperative clearing colonoscopy, synchronous high-risk adenomas (number ≥ 3, size ≥ 10 mm, high-grade dysplasia, villous histology, and serrated adenoma ≥ 10 mm) were detected in 95 patients (32.4%), and they were significantly associated with male sex, old age (≥ 65 years), current alcohol consumption, and current smoking (p < 0.05). During the follow-up period (mean 74.4 ± 36.4 months), advanced metachronous neoplasms were found in 45 patients (15.4%), including metachronous cancer in four (1.4%). In multivariate analysis, distal colon cancer (distal-to-splenic flexure; odds ratio [OR], 4.402; 95% confidence interval [CI], 1.658 to 11.689; p = 0.003), synchronous highrisk adenomas (OR, 3.225; 95% CI, 1.503 to 6.918; p = 0.003), and hypertension (OR, 2.270; 95% CI, 1.058 to 4.874; p = 0.035) were significant risk factors for advanced metachronous neoplasms. Conclusions: During surveillance after curative colon cancer resection, patients with distal colon cancer, synchronous high-risk adenomas, and hypertension may need meticulous follow-up to improve overall outcomes.

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Section: Discussionsupporting

confidence: 92%

Section: Discussioncontrasting

confidence: 78%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Risk factors of advanced metachronous neoplasms in surveillance after colon cancer resection

Nam

Shin

2021

Korean J Intern Med

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“…[ 9 ] Furthermore, Yun et al also showed that left colon resection had a higher incidence of adenoma than right colon resection in the second surveillance colonoscopy. [ 16 ] Because the incidence of adenoma in follow-up colonoscopy was significantly higher in patients with left colon cancer (arising from the descending and sigmoid colon, as well as the distal one-third of the transverse colon) than in patients with right colon cancer (arising from the ascending colon and proximal two-thirds of the transverse colon), [ 17 ] the purpose of this study was to investigate the incidence and related factors of SSAs after left colon cancer operation.…”

Section: Discussionmentioning

confidence: 99%

The incidence and risk factors of sessile serrated adenomas in left side colon cancer patients after curative surgery

et al. 2020

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Sessile serrated adenomas (SSAs) are precursors of colorectal cancer (CRC). However, there are limited data on detection rates of this premalignant lesion during colonoscopy surveillance in patients with a history of left side colonic resection for cancer. We aimed to identify the incidence and risk factors of SSAs in post-left side colectomy patients. We retrospectively reviewed the medical records of patients who had undergone left side colectomy for colon and rectal cancer between September 2009 and September 2016 and had at least 1 follow-up colonoscopy. Patient baseline characteristics, SSA diagnoses and characteristics, and colonoscopy information were collected. In total, 539 patients were enrolled. At the first follow-up (mean duration 11.5 months), 98 SSAs were identified (22.2%). At the second follow-up (mean duration 25.8 months), 51 SSAs were identified in 212 patients (24.0%). Multivariate analysis showed that alcohol intake (hazard ratio [HR] 1.524; 95% confidence interval [CI] .963–2.411, P = .041), excellent bowel preparation (HR 2.081; 95% CI 1.214–3.567, P = .049), and use of a transparent cap (HR 1.702; 95% CI 1.060–2.735, P = .013) were associated with higher SSA incidence in the first surveillance colonoscopy, while body mass index (BMI) ≥ 25.0 (HR 1.602; 95% CI 1.060–2.836) was associated with a significantly increased risk of SSAs in the second surveillance. Considering the endoscopic appearance of SSAs, adequate bowel preparation and use of transparent caps during postoperative surveillance colonoscopy can increase the diagnosis rate. Modification of alcohol intake and BMI may reduce the incidence of SSAs in left side colon cancer patients.

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IMMUNOREACT 9 metachronous rectal cancers have high HLA-ABC expression on healthy epithelium but a lower infiltration of CD3+ T cells than primary lesions

Salmaso,

Scarpa,

Pellegrini

et al. 2024

Sci Rep

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Lynch syndrome is rarely associated with rectal cancer (RC) and thus, metachronous RC has been scarcely investigated. This study aimed to analyze the mucosal immune microenvironment in sporadic and metachronous RC. We analyzed the mucosal immune microenvironment in the 25 metachronous RCs present in the IMMUNOREACT 1 and 2 multicentre observational studies (624 patients). A panel of immune markers was retrospectively investigated at immunohistochemistry: CD3, CD4, CD8, CD8b, Tbet, FoxP3, PD-L1, MSH6, and PMS2 and CD80. Single-cell suspensions were subjected to flow-cytometry to determine the proportion of epithelial cells (pan-cytokeratin) acting as antigen-presenting cells (expressing CD80, CD86, HLA-ABC) and the proportion of activated CD8 + T cells (CD8 + positive for CD28, CD38), inhibitory T cells (CD3 + CTLA-4+) of activated CD4 + T helper cells (CD4 + CD25+) and activated T regulatory cells (CD4 + CD25 + FoxP3+). No mismatch repair gene deficiencies were observed in the patients. The previous history of colorectal adenoma was significantly more frequent in metachronous RC. In healthy epithelial cells, HLA-ABC expression was significantly higher in patients with metachronous RC. In therapy-naïve metachronous RC patients, a significantly lower level of circulating lymphocytes and CD3 + T-cell infiltration in the healthy mucosa surrounding the RC was observed compared to patients with non-metachronous cancer. Our study supports the hypothesis that metachronous RC can occur in a cancerization field in patients with weak systemic and local immune systems. The peculiar site of RC makes the mismatch-repair genes deficiency in metachronous cancer onset less relevant. Supplementary Information The online version contains supplementary material available at 10.1038/s41598-024-80299-0.

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Left-Sided Colectomy: One of the Important Risk Factors of Metachronous Colorectal Adenoma After Colectomy for Colon Cancer

Abstract: The LCR group had a higher adenoma recurrence rate than the RCR group. Further studies are required to determine the optimal surveillance intervals according to the type of colonic resection.

Cited by 10 publications

References 24 publications

Risk factors of advanced metachronous neoplasms in surveillance after colon cancer resection

Risk factors of advanced metachronous neoplasms in surveillance after colon cancer resection

The incidence and risk factors of sessile serrated adenomas in left side colon cancer patients after curative surgery

IMMUNOREACT 9 metachronous rectal cancers have high HLA-ABC expression on healthy epithelium but a lower infiltration of CD3+ T cells than primary lesions

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