Risk factors for incomplete excision of colorectal polyps: a systematic review and meta-analysis

The object of this study was to explore the risk factors for incomplete excision of colorectal polyps (CP) through a systematic review and meta-analysis.

A comprehensive research of various databases, including CNKI, Wanfang Data, VIP, PubMed, Embase, Cochrane Library, and Web of Science, was carried out to confirm case-control studies investigating the risk factors for incomplete excision of CP. The search deadline was March 20, 2023. Analyses of the data were performed utilizing Stata 15.0.

The meta-analysis identified several factors significantly associated with the risk of residual or recurrent lesions. Polyps measuring ≥ 6 mm [OR = 1.494; 95%CI: 1.117-1.999; P = 0.007], flat polyps [OR = 1.81; 95%CI: 1.35, 2.41; P < 0.001], sessile serrated lesions [OR = 3.22; 95%CI: 1.93, 5.36; P < 0.001], high-grade intraepithelial neoplasia [OR = 2.34; 95%CI: 1.15, 4.76; P = 0.019], and polyps that underwent piecewise excision [OR = 3.10; 95%CI: 1.96, 4.90; P < 0.001] were all associated with increased risk. In contrast, adenomatous polyps [OR = 0.50; 95%CI: 0.26, 0.96; P = 0.036] were associated with a lower risk. Complete excision uncertainty was a protective factor for complete excision of CP [OR = 0.503, 95%CI (0.233, 1.087), P = 0.081]. In multivariate analysis, polyps ≥ 6 mm remained an independent predictor of residual or recurrent lesions [OR = 1.494, 95%CI (1.117, 1.999), P = 0.007].

Based on existing evidence, CP ≥ 6 mm, flat morphology, sessile serrated lesions, high-grade intraepithelial neoplasia, and piecewise excision could be risk factors for incomplete excision of CP.