Factors associated with complete endoscopic resection of an invasive adenocarcinoma in a colorectal adenoma.

BACKGROUND AND OBJECTIVE: endoscopic polypectomy may allow curative resection of invasive adenocarcinoma on colorectal adenoma. Our goal was to determine the factors associated with complete endoscopic resection of invasive adenocarcinoma.

METHODS: retrospective observational study. We included 151 patients with invasive adenocarcinoma on adenomas endoscopically resected between 1999 and 2009. We determined those variables independently related to incomplete resection by a logistic regression. Relation was expressed as Odds Ratio (OR) and its 95% confidence interval (95% CI).

RESULTS: patients were predominantly male (66.2%) and their mean age was 68.03 ± 10.65 years. Colonoscopy was completein 84% of the patients and 60.3% had synchronous adenomas. Invasive adenocarcinoma was mainly located in distal colon (90.7%) and morphology was pedunculated in 75.5%. The endoscopic averagesize was 22.61 ± 10.86 mm. Submucosal injection was required in 32.5%. Finally, the resection was in one piece in 73.5% and incomplete in 8.6% of the adenocarcinomas. Factors independently associated with incomplete endoscopic resection were size (mm) (OR 1.08, 95% CI 1.03-1.14, p = 0.002), sessile or flat morphology (OR 8.78, 95% CI 2.24-34.38, p = 0.002) and incomplete colonoscopy (OR 4.73, 95% CI 1.15-19.34, p = 0.03).

CONCLUSIONS: endoscopic polypectomy allows complete resection of 91.4% of invasive adenocarcinomas on colorrectal adenoma in our series. Factors associated with incomplete resection were the size of the lesion, sessile or flat morphology and incomplete colonoscopy.