Adenoma recurrence after left vs. right colectomy

Lorenzo Fuccio, MD, from the Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, in Bologna, Italy discusses this Original Article, “Higher adenoma recurrence rate after left- versus right-sided colectomy for colon cancer.”

This study assessed the risk of the development of metachronous precancerous lesions according to the site of colonic resection in patients with colon cancer. The findings of our study are meaningful for at least 3 reasons: i) Patients with a history of right-sided colon cancer might postpone the second surveillance colonoscopy for up to 5 years, whereas patients with previous left-sided colon cancer might maintain a 3-year interval; ii) as life expectancy of patients with history of colon cancer is increasing, this strategy would reduce the overall cost for patients and for the health care system; iii) our results would promote basic research to explore causes of different adenoma occurrence between the 2 groups of patients.

This study shows that patients with previous left-sided colon cancer have a significantly increased risk of the development of a metachronous adenoma during surveillance, after a mean of 5 years from surgical resection. Indeed, at least 1 adenoma was diagnosed in 76 of 256 patients (30% Adenoma Detection Rate, ADR) and in 35 of 185 patients (19% ADR) in the LCR and RCR groups, respectively (P=0.014), thus yielding an OR of 1.83 (95% CI, 1.16– 2.89). Corresponding figures for the polyp detection rate were 101 of 256 (39%) and 46 of 185 (25%), respectively (P=.002; OR 1.97; 95% CI, 1.30-3.00).

Figure 2. Polyp detection rate (PDR) and adenoma detection rate (ADR) according to the type of colonic resection (ie, right- and left-sided colectomy).

This data should be confirmed by a prospective study; furthermore, it should be investigated whether the different risk of the development of a metachronous adenoma during surveillance persists beyond the second surveillance colonoscopy.

Our study has several limitations, mainly due to the retrospective design. In particular, data on the number and type of adenomas at preoperative colonoscopy are missing. Similarly, we did not have full information concerning the first postoperative colonoscopy for about two-thirds of the study population because most of the procedures were performed at outside the study centers. All these limitations should be overcome in future studies.

Read the abstract for this article here.

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