Local recurrence rates after resection of large colorectal serrated lesions with or without margin thermal ablation

Abstract

Introduction

Serrated lesions (SLs) including traditional serrated adenomas (TSA), large hyperplastic polyps (HP) and sessile serrated lesions (SSLs) are associated with high incomplete resection rates. Margin ablation combined with EMR (EMR-T) has become routine to reduce local recurrence while cold snare polypectomy (CSP) is becoming recognized as equally effective for large SLs. Our aim was to evaluate local recurrence rates (LRR) and the use of margin ablation in preventing recurrence in a retrospective cohort study.

Methods

Patients undergoing resection of ≥15 mm colorectal SLs from 2010-2022 were identified through a pathology database and electronic medical records search. Hereditary CRC syndromes, first follow-up > 18 months or no follow-up, surgical resection were excluded. Primary outcome was LRRs (either histologic or visual) during the first 18-month follow-up. Secondary outcomes were LRRs according to size, and resection technique.

Results

191 polyps in 170 patients were resected (59.8% women; mean age, 65 years). The mean size of polyps was 22.4 mm, with 107 (56.0%) ≥20 mm. 99 polyps were resected with EMR, 39 with EMR-T, and 26 with CSP. Mean first surveillance was 8.2 mo. Overall LRR was 18.8% (36/191) (16.8% for ≥20 mm, 17.9% for ≥30 mm). LRR was significantly lower after EMR-T when compared with EMR (5.1% vs. 23.2%; p = 0.013) or CSP (5.1% vs. 23.1%; p = 0.031). There was no difference in LRR between EMR without margin ablation and CSP (p = 0.987).

Conclusion

The local recurrence rate for SLs ≥15 mm is high with 18.8% overall recurrence. EMR with thermal ablation of the margins is superior to both no ablation and CSP in reducing LRRs.

Keywords:

• Serrated
• Polyp
• EMR
• Thermal ablation
• Local recurrence

Disclosure statement

No potential conflict of interest was reported by the author(s).

DvR is supported by the “Fonds de Recherche du Québec Santé” career development award and has received research funding from ERBE, Ventage, Pendopharm, and Pentax and is a consultant for Boston Scientific and Pendopharm. All other investigators have no relevant conflict of interests to disclose.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Roupen Djinbachian

Roupen Djinbachian, MD: Study concept and design; acquisition of data; drafting of the manuscript; analysis and interpretation of data; critical revision of the manuscript for important intellectual content.

Laetitia Amar

Laetitia Amar, MD: Acquisition of data; analysis and interpretation of data; critical revision of the manuscript for important intellectual content.

Heiko Pohl

Heiko Pohl, MD: Critical revision of the manuscript for important intellectual content.

Widad Safih

Widad Safih: Critical revision of the manuscript for important intellectual content.

Simon Bouchard

Simon Bouchard: Acquisition of data; critical revision of the manuscript for important intellectual content.

Erik Deslandres

Erik Deslandres: Acquisition of data; critical revision of the manuscript for important intellectual content.

Judy Dorais

Judy Dorais: Acquisition of data; critical revision of the manuscript for important intellectual content.

Daniel von Renteln

Daniel von Renteln, MD: Study concept and design; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content.