Tumor Seeding During Colonoscopy as a Possible Cause for Metachronous Colorectal Cancer

Backes, Yara; Seerden, Tom; Gestel, Rosanne S.F. E. van; Kranenburg, Onno; Ubink, Inge; Schiffelers, Raymond M.; Straten, Demian van; Capellen, Malu S. van der; Weerd, S. van de; Leng, Wendy W.J. de; Siersema, Peter D.; Offerhaus, G. Johan A.; Morsink, Folkert H.M.; Ramphal, Winesh; Droste, Jochiim Terhaar Sive; Lent, Anja U.G. van; Geesing, Joost M J; Vleggaar, Frank P.; Elias, Sjoerd G.; Laclé, Miangela M.; Moons, Leon M.G.

doi:10.1053/j.gastro.2019.07.062

Cited by 49 publications

(35 citation statements)

References 29 publications

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“…In contrast to interval CRC, which refers to cancer that develops shortly after screening/surveillance colonoscopy, PCCRC encompasses cancers that develops after any diagnostic colonoscopy and could account for up to 9% of all diagnosed CRCs, with a predilection for proximal colon . The mechanisms for PCCRC development could be accounted by incomplete colonoscopy (due to technical difficulty or luminal obstruction), missed lesions at the index colonoscopy (around 50% of the cases), incomplete resection of polyps, tumours arising from alternative pathway including the sessile serrated pathway with rapid growth and tumour seeding by biopsy forceps or needle injectors …”

Section: Introductionmentioning

confidence: 99%

Nonsteroidal anti‐inflammatory drugs but not aspirin are associated with a lower risk of post‐colonoscopy colorectal cancer

Cheung

Chen

Chan

et al. 2020

Aliment Pharmacol Ther

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Background: Although nonsteroidal anti-inflammatory drugs (NSAIDs) reduce colorectal cancer (CRC) risk, their role in preventing post-colonoscopy CRC (PCCRC) remains undetermined. Aims: To investigate whether NSAIDs reduce PCCRC risk after a negative baseline colonoscopy Methods: This is a retrospective cohort study based on a territory-wide healthcare database of Hong Kong. All patients (aged 40 or above) who underwent colonoscopies between 2005 and 2013 were identified. Exclusion criteria included CRC detected within 6 months of index colonoscopy, prior CRC, inflammatory bowel disease and prior colectomy. The primary outcome was PCCRC-3y diagnosed between 6 and 36 months after index colonoscopy. Sites of CRC were categorised as proximal (proximal to splenic flexure) and distal. The adjusted hazards ratio (aHR) of PCCRC-3y with NSAID and aspirin use (defined as cumulative use for ≥90 days within 5 years before index colonoscopy) was derived by propensity score (PS) regression adjustment of 22 covariates (including patient factors, concurrent medication use and endoscopy centre's performance).Results: Of 187 897 eligible patients, 21 757 (11.6%) were NSAID users. 854 (0.45%) developed PCCRC-3y (proximal cancer: 147 [17.2%]). NSAIDs were associated with a lower PCCRC-3y risk (aHR: 0.54, 95% CI: 0.41-0.70), but not CRC that developed >3 years (aHR: 0.78, 95% CI 0.56-1.09). The aHR was 0.48 (95% CI: 0.24-0.95) for proximal and 0.55 (95% CI: 0.40-0.74) for distal cancer. A duration-and frequency response relationship was observed (P trend < 0.001). For aspirin, the aHR was 1.01 (95% CI: 0.80-1.28). Conclusions:Non-aspirin NSAIDs were associated with lower PCCRC risk after a negative baseline colonoscopy. R E FE R E N C E S

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Section: Introductionmentioning

confidence: 99%

Nonsteroidal anti‐inflammatory drugs but not aspirin are associated with a lower risk of post‐colonoscopy colorectal cancer

Cheung

Chen

Chan

et al. 2020

Aliment Pharmacol Ther

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“…7 Other rare causes of postcolonoscopy cancers include incomplete colonoscopies, rapidly growing tumors, new lesions, and even iatrogenic seeding of CRC during colonoscopy. 5,8 More recently, the influence of incomplete polyp resection as a major contributor of interval CRC has been brought to attention. 9,10 Studies have shown that 20% to 30% of interval CRC cases are attributable to incomplete resection of CRC precursors, with interval CRC cases often occurring at previous polypectomy sites or colon segments.…”

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confidence: 99%

Rates of Incomplete Resection of 1- to 20-mm Colorectal Polyps: A Systematic Review and Meta-Analysis

Djinbachian¹,

Iratni²,

Durand³

et al. 2020

Gastroenterology

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This article has an accompanying continuing medical education activity, also eligible for MOC credit, on page e19. Learning Objective: Upon completion of this CME activity, successful learners will be able to describe key colonoscopy quality metrics and employ proper polypectomy techniques in different clinical situations. BACKGROUND & AIMS: Incomplete resection of neoplastic colorectal polyps can result in postcolonoscopy colorectal cancer. We performed a systematic review and meta-analysis to determine the incomplete resection rate (IRR) of colorectal polyps and associated factors. METHODS: We searched MED-LINE, EMBASE, EBM Reviews, and CINAHL to identify full-text articles that reported IRRs of polyps 1 to 20 mm, published until March 2019. Exclusion criteria were studies of inflammatory bowel disease cohorts, referrals for difficult polypectomy, polyp sizes larger than 20 mm, and endoscopic submucosal resection and/or dissection as polypectomy approaches. IRRs were calculated based on findings from biopsies taken at polypectomy sites or assessments of margins of resected polyps. The primary outcome was IRR for snare removal of polyps 1 to 20 mm. Secondary outcomes included IRR for polyps 1 to 10 mm and 10 to 20 mm, IRR for hot and cold snare removal of polyps 1 to 10 mm and 10 to 20 mm, IRR of snare removal with or without submucosal injection, and IRR for forceps and cold snare removal of polyps 1 to 5 mm. RESULTS: We identified 6148 reports and used 32 studies, with a total of 9282 polyps, in our quantitative analysis. The IRR for snare removal of polyps 1 to 20 mm was 13.8% (95% confidence interval [CI] 10.3-17.3; 13 studies, 5128 polypectomies). IRRs were 15.9% for snare removal of polyps 1 to 10 mm (95% CI 9.6-22.1; 9 studies, 2531 polypectomies) and 20.8% for snare removal of polyps 10 to 20 mm (95% CI 12.9-28.8; 6 studies, 412 polypectomies). The IRR for hot snare removal of polyps 1 to 10 mm was 14.2% (95% CI 5.2-23.2) vs 17.3% for cold snare polypectomy (95% CI 14.3-20.3). The IRR for forceps removal of polyps 1 to 5 mm was 9.9% (95% CI 7.1-13.0) vs 4.4% for snare polypectomy (95% CI 2.9-6.1). CONCLUSIONS: In a systematic review and meta-analysis, we found that colorectal polyps 1 to 20 mm are frequently incompletely resected, and that risk increases for polyps 10 mm or larger. There is no difference in IRRs of cold vs hot snares for polyps 1 to 10 mm. Snare polypectomy should be used over forceps for polyps 1 to 5 mm.

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“…LSTs with cancerous histology were reported associated with the adenoma recurrence after endoscopic therapy [21]. What is more, tumor seeding during colonoscopy is a possible cause for metachronous colorectal cancer [22]. Therefore, en bloc resection is essential if the malignant LSTs are suspected, which ensures the effectiveness of treatment, reduces the recurrence of polyps and LSTs, and potentially decreases the incidence of cancerous LST seeding [21][22][23].…”

Section: Discussionmentioning

confidence: 99%

The Coexistence of Colorectal Polyps in the Right Colon Increases the Malignant Risk of Laterally Spreading Tumors

Shen

Zhang

Zhao

et al. 2020

Gastroenterology Research and Practice

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Background. The coexistence of colorectal polyps with laterally spreading tumors (LSTs) is commonly observed during colonoscopy. However, there are rare studies that assess the malignant risks for LSTs with colorectal polyps, which might largely contribute to further strategies of treatment and follow-up plans in LSTs. Methods. We conducted a retrospective cohort study that enrolled 206 patients with LSTs in the Endoscopy Center and Endoscopy Research Institute, Renji Hospital, Shanghai Jiao Tong University, China. The subjects with LSTs were divided into two groups: the nonpolyp group with 89 patients and the polyp group with 117 patients. Binary logistic regression was used to identify the independent predictors of outcomes of interest. Results. The risk of the polyps’ coexistence phenomenon increased in males compared with females (OR=2.138, p=0.047), especially in those between 50 and 75 years old (OR=7.074, p=0.036). Tumor size (3–4 cm), LSTs with tubulovillous types, and history of polyps statistically increased the risk of the polyp coexistence phenomenon (OR=5.768, p=0.003; OR=36.345, p=0.024; OR=13.245, p<0.0001, respectively). LST-NG-PD (OR=20.982, p=0.017) and LSTs≥5 cm (OR=37.604, p=0.038) notably increased the malignant risk of LSTs. When the simultaneous polyps are located in the right colon, the risk of malignant LSTs (OR=58.540, p=0.013) positively increased. Conclusion. The simultaneous colorectal polyps in the right colon were the most important risk factor to predict the malignant risk of LSTs.

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Tumor Seeding During Colonoscopy as a Possible Cause for Metachronous Colorectal Cancer

Cited by 49 publications

References 29 publications

Nonsteroidal anti‐inflammatory drugs but not aspirin are associated with a lower risk of post‐colonoscopy colorectal cancer

Nonsteroidal anti‐inflammatory drugs but not aspirin are associated with a lower risk of post‐colonoscopy colorectal cancer

Rates of Incomplete Resection of 1- to 20-mm Colorectal Polyps: A Systematic Review and Meta-Analysis

The Coexistence of Colorectal Polyps in the Right Colon Increases the Malignant Risk of Laterally Spreading Tumors

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