Low Colorectal Cancer Risk After Resection of High-Risk Pedunculated Polyps

Area of Science:

• Gastroenterology
• Oncology
• Public Health

Background:

• Post-fecal immunochemical test (FIT) colonoscopy has a high prevalence of advanced adenomas.
• Increased risk of colorectal cancer (CRC) necessitates postpolypectomy surveillance, burdening endoscopy services.

Purpose of the Study:

• To investigate postpolypectomy CRC risk in FIT-positive (FIT+) individuals after low-risk adenoma (LRA) or high-risk adenoma (HRA) resection.
• To identify factors influencing CRC risk in screening populations.

Main Methods:

• Retrieved data from a FIT-based CRC screening program in Italy (2002-2017), followed up to December 2021.
• Analyzed CRC incidence and mortality based on adenoma type (LRA/HRA), morphology, size, dysplasia, and location.
• Compared risks with FIT+/colonoscopy-negative and FIT- patients using Cox regression models.

Main Results:

• CRC incidence was not increased in LRA patients compared to FIT+/colonoscopy-negative.
• A significant increase in CRC incidence was observed in HRA patients (HR, 1.53).
• Proximal location, non-pedunculated morphology, and high-grade dysplasia in HRAs explained excess CRC risk (HR, 1.85).

Conclusions:

• Colorectal cancer incidence is significantly higher in patients with HRAs.
• Patients with distal pedunculated polyps without high-grade dysplasia showed no increased CRC risk.
• This observation could potentially reduce surveillance burden in FIT programs.