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News

Long-term colorectal-cancer mortality after adenoma removal

This week's issue of the New England Journal of Medicine estimates colorectal-cancer mortality among patients who had undergone removal of colorectal adenomas.

News image

Although colonoscopic surveillance of patients after removal of adenomas is widely promoted, little is known about colorectal-cancer mortality among these patients.

Using the linkage of the Cancer Registry and the Cause of Death Registry of Norway, Dr Magnus Løberg and colleagues estimated colorectal-cancer mortality among patients who had undergone removal of colorectal adenomas during the period from 1993 through 2007.

Patients were followed through 2011.

The research team calculated standardized incidence-based mortality ratios using rates for the Norwegian population at large for comparison.

Norwegian guidelines recommended colonoscopy after 10 years for patients with high-risk adenomas, and after 5 years for patients with 3 or more adenomas.

The team found that no surveillance was recommended for patients with low-risk adenomas.

The standardized incidence-based mortality ratio was 0.96 for patients who had had adenomas removed
New England Journal of Medicine

Polyp size and exact number were not available in the registry.

The researchers defined high-risk adenomas as multiple adenomas and adenomas with a villous component or high-grade dysplasia.

The team identified 40,826 patients who had had colorectal adenomas removed.

During a median follow-up of 7 years, 1273 patients were given a diagnosis of colorectal cancer.

A total of 398 deaths from colorectal cancer were expected, and 383 were observed, for a standardized incidence-based mortality ratio of 0.96 among patients who had had adenomas removed.

The researchers noted that colorectal-cancer mortality was increased among patients with high-risk adenomas, but it was reduced among patients with low-risk adenomas.

Dr Løberg's team comments, "After a median of 7.7 years of follow-up, colorectal-cancer mortality was lower among patients who had had low-risk adenomas removed, and moderately higher among those who had had high-risk adenomas removed, as compared with the general population."

N Engl J Med 2014; 371:799-807
28 August 2014

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