January 22, 2020
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CRC surveillance may be unnecessary after polypectomy in some patients

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Patients at low and intermediate risk for colorectal cancer may not require postpolypectomy surveillance, according to research published in Gut.

Amanda J. Cross, PhD, of the department of surgery and cancer at Imperial College London, and colleagues wrote that current guidelines may put a burden on colonoscopy resources.

“Revision of the guidelines is required to minimize unnecessary colonoscopies while ensuring that patients at increased CRC risk receive surveillance,” they wrote. “We aimed to identify patient subgroups who could safely forgo surveillance or receive less than currently recommended.”

Researchers conducted a retrospective study comprising 28,972 patients who underwent colonoscopy with adenoma removal and a median follow-up of 9.3 years. They estimated the effect of surveillance on CRC incidence after adjusting for patient characteristics and other factors.

In the study cohort, investigators classified 14,401 patients as low risk (50%), 11,852 as intermediate risk (41%) and 2,719 as high risk (9%). They reported CRC incidences of 140 per 100,00 person-years (95% CI, 122-162), 221 per 100,000 person-years (95% CI, 195-251) and 366 per 100,000 person-years (95% CI, 295-453) in the three groups, respectively.

Additionally, Cross and colleagues found that CRC incidence was lower with a single surveillance visit than with none in the low- (HR = 0.56; 95% CI, 0.39-0.8), intermediate- (HR = 0.59; 95% CI, 0.43-0.81) and high-risk groups (HR = 0.49; 95% CI, 0.29-0.82).

Compared with the general population, CRC incidence without surveillance was similar among the low- (standardized incidence ratio [SIR] = 0.86; 95% CI, 0.73-1.02) and intermediate- (SIR = 1.16; 95% CI, 0.97-1.37) risk groups, whereas it was higher among patients with higher risk (SIR = 1.91; 95% CI, 1.39-2.56).

Cross and colleagues wrote that low-risk patients and intermediate-risk patients without high-grade dysplasia or proximal polyps do not remain at increased CRC risk after a complete baseline colonoscopy and polypectomy.

“Surveillance is probably not necessary for these patients and routine screening would suffice, although patients should be reminded to contact their general practitioner if lower gastrointestinal symptoms occur,” they wrote. “Conversely, surveillance is warranted for high-risk patients, and intermediate-risk patients without a complete baseline colonoscopy or with high-grade dysplasia or proximal polyps, whose risk was higher than in the general population before surveillance.” – by Alex Young

Disclosures: Cross reports she receives funding from the National Institute for Health Research Health Technology Assessment, the Bobby Moore Fund for Cancer Research UK and the Cancer Research UK Population Research Committee Program Award. Please see the study for all other authors’ relevant financial disclosures.