Identification of the patients with the high risk of recurrent colorectal lesions based on the clinicopathological phenotype – prospective study

Aims In colonoscopies with positive findings, endoscopy removal of colorectal neoplasia is indicated. The surveillance (follow-up, FU) colonoscopies follow with the aim to diagnose the recurrent and metachronous lesions. Many guidelines recommend the intervals of such procedures based on the number, size and histopathological phenotype of the resected lesions. In clinical practice, the adherence of the recommendations is variable and selection of the high-risk patients who will benefit from shorter intervals might be helpful. Therefore, detailed study focusing on the development and clinical utilization of the new method combining the clinicopathological phenotype and the mutation burden was started in 2017. The interim results of the clinical phase of this prospective study are described.

Methods Patients with colorectal lesions≥10 mm removed by advanced therapeutic methods (en-bloc mucosal resection and submucosal dissection) and followed in interval in year 1, 3 and 5 were included. The therapy and surveillance were performed in one tertiary endoscopy center. The main aim was to assess the metachronous lesions (number, size, locality, histopathology characteristics) in relation with the index colonoscopy findings. Secondary aim was evaluation of the local residual neoplasia (LRN) in the scar after previous therapy.

Results There were 217 patients included in the study in years 2017 – 2020. Eight of them were excluded because they did not meet the inclusion criteria. Results of the index colonoscopy in 209 patients (130 men, 62,2%; 79 women, 37,8%) were analyzed. 275 index lesions were found, majority of them (238 lesions, 86,5%, low-grade and high-grade adenomas) were benign and there were 12 (4,4%) intramucosal cancers, two T1 cancers, one T2 cancers and one NET. 21 lesions were hyperplastic or others. Follow-up colonoscopy in one year was performed in 178 patients (82,0%) and in 91 of them (51,1%) metachronous lesions were found, 120 (64,2%) adenomas, 46 (24,6%) hyperplastic and 21 (11.2%) others, with no cancer. LRN was diagnosed in 5,5% patients. In 122 patients with 3-years FU colonoscopy, 59 (48,4%) had metachronous lesions, mostly adenomas (73; 72,3%), no cancer and one LRN found. 45 patients had 5-years FU colonoscopy so far, 22 of them (48,9%) with metachronous lesions, mostly adenomas (25; 54,3%), no cancer, LRN in one case.

Conclusions In patients after removal of the high-risk colorectal lesions defined by size≥10 mm, high numbers of metachronous lesions were found in the strict surveillance protocol (years 1, 3, and 5). All of the lesions were benign, with no cancer found. Supported by program projects of the Ministry of Health of the Czech Republic with reg. no. NU22-08-00424, MO1012 and Cooperatio

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Artikel online veröffentlicht:
27. März 2025