Background: To investigate the cause and risk of interval colorectal cancer (ICC) in patients undergoing surveillance colonoscopy within 5 years after colonoscopic polypectomy. Patients and Methods: We retrospectively analyzed data (endoscopy, pathology, demography) of patients who received surveillance colonoscopy within 5 years after colonoscopic polypectomy. Results: Among 1,794 patients undergoing surveillance colonoscopy within 5 years after colonoscopic polypectomy, 14 suffered from ICC. The mean follow-up time was 2.67 years and the incidence density of ICC was 2.9 cases per 1,000 person-years. 50% of ICCs were found in patients in whom adenomas had been incompletely removed by endoscopic therapy, 36% were missed cancers, and 14% were new cancers. Age >60 years (OR 2.97, 95% CI 2.31–3.82) was significantly associated with interval cancer on the surveillance colonoscopy as were advanced adenoma (OR 1.28, 95% CI 1.01–1.62), the presence of villous (HR 1.38, 95% CI 1.03–1.85) and high-grade dysplasia (OR 1.61, 95% CI 1.07–2.42). Conclusions: Among patients undergoing surveillance colonoscopy within 5 years after polypectomy, the incidence density of ICC was 2.9 cases per 1,000 person-years. The majority of interval cancers originated from incomplete resection of advanced adenomas and missed cancers, which can be prevented by improving endoscopic techniques and selecting an appropriate follow-up time interval.

Mandel JS, Church TR, Bond JH, Ederer F, Geisser MS, Mongin SJ, Snover DC, Schuman LM: The effect of fecal occult-blood screening on the incidence of colorectal cancer. N Engl J Med 2000;343:1603–1607.
Citarda F, Tomaselli G, Capocaccia R, Barcherini S, Crespi M: Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence. Gut 2001;48:812–815.
Winawer SJ, Zauber AG, Ho MN, O’Brien MJ, Gottlieb LS, Sternberg SS, Waye JD, Schapiro M, Bond JH, Panish JF, et al: Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 1993;329:1977–1981.
Martinez ME, Baron JA, Lieberman DA, Schatzkin A, Lanza E, Winawer SJ, Zauber AG, Jiang R, Ahnen DJ, Bond JH, Church TR, Robertson DJ, Smith-Warner SA, Jacobs ET, Alberts DS, Greenberg ER: A pooled analysis of advanced colorectal neoplasia diagnoses after colonoscopic polypectomy. Gastroenterology 2009;136:832–841.
Leung WK, Lau JY, Suen BY, Wong GL, Chow DK, Lai LH, To KF, Yim CK, Lee ES, Tsoi KK, Ng SS, Sung JJ: Repeat-screening colonoscopy 5 years after normal baseline-screening colonoscopy in average-risk Chinese: a prospective study. Am J Gastroenterol 2009;104:2028–2034.
Heresbach D, Barrioz T, Lapalus MG, Coumaros D, Bauret P, Potier P, Sautereau D, Boustiere C, Grimaud JC, Barthelemy C, See J, Serraj I, D’Halluin PN, Branger B, Ponchon T: Miss rate for colorectal neoplastic polyps: a prospective multicenter study of back-to-back video colonoscopies. Endoscopy 2008;40:284–290.
Huang Y, Liu S, Gong W, Zhi F, Pan D, Jiang B: Clinicopathologic features and endoscopic mucosal resection of laterally spreading tumors: experience from China. Int J Colorectal Dis 2009;24:1441–1450.
Winawer SJ, Zauber AG: Colonoscopic polypectomy and the incidence of colorectal cancer. Gut 2001;48:753–754.
Hamilton SR, Vogelstein B, Kudo S: Carcinoma of the colon and rectum; in Hamilton SR, Altonen IA (eds): Tumours of the Digestive System WHO Classification of Tumors. Lyon, IARC Press, 2000, pp 113–114.
Pabby A, Schoen RE, Weissfeld JL, Burt R, Kikendall JW, Lance P, Shike M, Lanza E, Schatzkin A: Analysis of colorectal cancer occurrence during surveillance colonoscopy in the dietary polyp prevention trial. Gastrointest Endosc 2005;61:385–391.
Robertson DJ, Greenberg ER, Beach M, Sandler RS, Ahnen D, Haile RW, Burke CA, Snover DC, Bresalier RS, McKeown-Eyssen G, Mandel JS, Bond JH, Van Stolk RU, Summers RW, Rothstein R, Church TR, Cole BF, Byers T, Mott L, Baron JA: Colorectal cancer in patients under close colonoscopic surveillance. Gastroenterology 2005;129:34–41.
Alberts DS, Martinez ME, Roe DJ, Guillen-Rodriguez JM, Marshall JR, van Leeuwen JB, Reid ME, Ritenbaugh C, Vargas PA, Bhattacharyya AB, Earnest DL, Sampliner RE: Lack of effect of a high-fiber cereal supplement on the recurrence of colorectal adenomas. Phoenix Colon Cancer Prevention Physicians’ Network. N Engl J Med 2000;342:1156–1162.
Jorgensen OD, Kronborg O, Fenger C: The Funen Adenoma Follow-Up Study. Incidence and death from colorectal carcinoma in an adenoma surveillance program. Scand J Gastroenterol 1993;28:869–874.
Winawer SJ, Zauber AG, O’Brien MJ, Ho MN, Gottlieb L, Sternberg SS, Waye JD, Bond J, Schapiro M, Stewart ET, et al: Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps. The national polyp study workgroup. N Engl J Med 1993;328:901–906.
Hotta K, Fujii T, Saito Y, Matsuda T: Local recurrence after endoscopic resection of colorectal tumors. Int J Colorectal Dis 2009;24:225–230.
Bressler B, Paszat LF, Chen Z, Rothwell DM, Vinden C, Rabeneck L: Rates of new or missed colorectal cancers after colonoscopy and their risk factors: a population-based analysis. Gastroenterology 2007;132:96–102.
Rex DK: Still photography versus videotaping for documentation of cecal intubation: a prospective study. Gastrointest Endosc 2000;51:451–459.
Marshall JB, Brown DN: Photodocumentation of total colonoscopy: how successful are endoscopists? Do reviewers agree? Gastrointest Endosc 1996;44:243–248.
Winawer SJ, Fletcher RH, Miller L, Godlee F, Stolar MH, Mulrow CD, Woolf SH, Glick SN, Ganiats TG, Bond JH, Rosen L, Zapka JG, Olsen SJ, Giardiello FM, Sisk JE, Van Antwerp R, Brown-Davis C, Marciniak DA, Mayer RJ: Colorectal cancer screening: clinical guidelines and rationale. Gastroenterology 1997;112:594–642.
Jarvinen HJ, Mecklin JP, Sistonen P: Screening reduces colorectal cancer rate in families with hereditary non-polyposis colorectal cancer. Gastroenterology 1995;108:1405–1411.
Lanspa SJ, Jenkins JX, Cavalieri RJ, Smyrk TC, Watson P, Lynch J, Lynch HT: Surveillance in lynch syndrome: how aggressive? Am J Gastroenterol 1994;89:1978–1980.
Atkin WS, Morson BC, Cuzick J: Long-term risk of colorectal cancer after excision of rectosigmoid adenomas. N Engl J Med 1992;326:658–662.
Leung K, Pinsky P, Laiyemo AO, Lanza E, Schatzkin A, Schoen RE: Ongoing colorectal cancer risk despite surveillance colonoscopy: The Polyp Prevention Trial Continued Follow-Up Study. Gastrointest Endosc 2009;71:111–117.
Kaminski MF, Regula J, Kraszewska E, Polkowski M, Wojciechowska U, Didkowska J, Zwierko M, Rupinski M, Nowacki MP, Butruk E: Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med 2010;362:1795–1803.
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