Revista espanola de enfermedades digestivas · 2025
Uncovering missed opportunities - A root-cause analysis of post-colonoscopy colorectal cancer in a tertiary care setting.
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Ruiz-Rodríguez Jorge, Román de la Fuente Carolina, Torres Nieto María Ángeles, Bayo Juanas Paula, Ruiz Núñez Isabel, Martínez Cuevas Cristina, Sanjosé Crespo Alicia, Díez Redondo Pilar, García-Alonso Francisco Javier
Аннотация
INTRODUCTION: colorectal cancer (CRC) is a leading cause of cancer-related mortality. CRCs diagnosed after a colonoscopy with no cancer detected (post-colonoscopy colorectal cancers [PCCRCs]) remain a quality concern.
OBJECTIVES: to estimate the proportion of PCCRC, identify their most plausible causes, and describe tumor characteristics and patient outcomes.
MATERIAL AND METHODS: a retrospective single-center study was performed including all CRC cases diagnosed between May 2018 and April 2022. These were cross-referenced with all colonoscopies performed between May 2009 and April 2022. PCCRCs were defined using World Endoscopy Organization criteria. Clinical data, colonoscopy quality indicators, and outcomes were retrieved from medical records and analyzed descriptively.
RESULTS: among 660 CRC cases, 55 (8.3 %) were classified as PCCRC. Most were males (61.8 %) with a median age of 72 (IQR 65-81). The three- and four-year PCCRC rates were 3.0 % and 3.9 %, respectively. High-risk factors were present in 14.5 % of patients. Tumors were mostly located in the right colon and rectum. Advanced-stage cancer (stage III/IV) was diagnosed in 43.1 % of cases. The most frequent etiology (69.1 %) was a missed lesion during a prior adequate colonoscopy. Incomplete resection accounted for 12.7 % of cases. Stage IV CRC (HR: 6.93 [95 % CI: 2.24-21.4], p = 0.001) and age at diagnosis (HR: 1.08 [1.02-1.14], p = 0.01) were associated with a higher risk of death according to multivariable analysis.
CONCLUSIONS: the majority of PCCRCs resulted from missed lesions, especially in the right colon and rectum. Enhancing mucosal visualization, improving bowel preparation, and optimizing polypectomy may reduce these rates.
OBJECTIVES: to estimate the proportion of PCCRC, identify their most plausible causes, and describe tumor characteristics and patient outcomes.
MATERIAL AND METHODS: a retrospective single-center study was performed including all CRC cases diagnosed between May 2018 and April 2022. These were cross-referenced with all colonoscopies performed between May 2009 and April 2022. PCCRCs were defined using World Endoscopy Organization criteria. Clinical data, colonoscopy quality indicators, and outcomes were retrieved from medical records and analyzed descriptively.
RESULTS: among 660 CRC cases, 55 (8.3 %) were classified as PCCRC. Most were males (61.8 %) with a median age of 72 (IQR 65-81). The three- and four-year PCCRC rates were 3.0 % and 3.9 %, respectively. High-risk factors were present in 14.5 % of patients. Tumors were mostly located in the right colon and rectum. Advanced-stage cancer (stage III/IV) was diagnosed in 43.1 % of cases. The most frequent etiology (69.1 %) was a missed lesion during a prior adequate colonoscopy. Incomplete resection accounted for 12.7 % of cases. Stage IV CRC (HR: 6.93 [95 % CI: 2.24-21.4], p = 0.001) and age at diagnosis (HR: 1.08 [1.02-1.14], p = 0.01) were associated with a higher risk of death according to multivariable analysis.
CONCLUSIONS: the majority of PCCRCs resulted from missed lesions, especially in the right colon and rectum. Enhancing mucosal visualization, improving bowel preparation, and optimizing polypectomy may reduce these rates.