Postcolonoscopy colorectal cancer: What we need to know in the age of screening and magnifying endoscopy techniques

Post-colonoscopic colorectal cancer (PCCRC), also known as interval CRC, is defined as CRC diagnosed more than six months after a colonoscopy in which no cancer was detected. It typically arises from missed lesions or incomplete resections and is now recognized as one of the most reliable quality indicators for assessing colonoscopy performance. With an incidence rate of 3.6% to 9.3%, PCCRC remains a significant concern, highlighting the limitations of colonoscopy in CRC screening-not only in terms of diagnostic accuracy but also in its preventive role and effectiveness in treating lesions. A range of clinical, endoscopic, and biological factors has been associated with an increased risk of PCCRC. Identifying these factors can help stratify high-risk patients, enabling earlier detection and improving preventive strategies for interval CRC. Reducing PCCRC should be a top priority for every endoscopy unit. While technological advancements will enhance polyp detection, minimize missed lesions, prevent incomplete resections, and improve overall procedural quality, the most impactful strategy remains internal self-assessment within each unit. This review should evaluate key performance metrics, including cecal intubation rate, adenoma detection rate, withdrawal time, PCCRC incidence, and incomplete resections-both at the individual endoscopist level and across the entire unit.