Vol.6, No 1, 1999 pp. 90 - 96
UC 616.35
METACHRONOUS COLORECTAL TUMORS IN PATIENTS
WITH REGULAR COLONOSCOPIC FOLLOW-EXAMINATIONS
Aleksandar Nagorni
Clinic of Gastroenteology and Hepatology, Faculty of medicine, Niš,
Yugoslavia
Summary. Metachronous colorectal tumors are common colonoscopic
finding. Metachronous colorectal adenomas are detected in 20-70.3% of patients,
but metachronous colorectal carcinoma (CRC) in 0.5-9% patiens. In this
prospective study, 120 patients (80 male, 40 female, mean age 57.9, range
31-77) were evaluated for metachronous tumors after colonoscopic polypectomy
for benign single/multiple colorectal tumors or colorectal surgery for
CRC. There were 34 (28.33%) patients in whom 58 metachronous tumors (benign
and malignant) were detected 12-48 months after previous intervention,
localised in different colorectal segments. Metachronous tumors were more
frequent in patients with initial multiple tumors than in patients with
initial single colorectal tumor. Most of the tumors were found within 24
months from colonoscopic polypectomy or colorectal surgery. It is supposed
that initial advanced adenoma and malignant alterated adenoma could be
adittional risk factors for development of metachronous adenoma. Metachronous
CRC were detected in 6.47-7.69% metachronous tumors in patients originating
from different initial groups. Regular colonoscopic follow-up examinations
after colonoscopic polypectomy or colorectal surgery for CRC are required.
Follow-up colonoscopies may detect colorectal adenomas with different degrees
of dysplastic changes, but colonoscopic polypectomy may prevent transformation
of adenoma to CRC (adenoma - carcinoma sequence). In the same time follow-up
colonoscopies may detect metachronous CRC in early stage, when prognosis
after colorectal surgery is much better than after colorectal surgery for
advanced metachronous CRC.
Key words: Metachronous adenoma, metachronous CRC, colonoscopy,
colonoscopic polypectomy
METAHRONI KOLOREKTALNI TUMORI U BOLESNIKA
SA PRAVILNIM KONTROLNIM KOLONOSKOPSKIM PREGLEDIMA
Kratak sadržaj: Metahroni kolorektalni tumori su čest kolonoskopski
nalaz. Metahroni kolorektalni adenomi se otkrivaju u 20-70.3% bolesnika,
a metahroni kolorektalni karcinomi (CRC) u 0.5-9% bolesnika. U prospektivnu
studiju, nakon kolonoskopske polipektomije benignih solitarnih ili multiplih
kolorektalnih tumora ili nakon operacije debelog creva zbog CRC. Uključeno
je 120 bolesnika (80 muškaraca i 40 žena, prosečne starosti 57,9 godina,
31-77 godina). U bolesnika su procenjivani metahroni tumori. U 34 (28.33%)
bolesnika otkriveno je 58 benignih i malignih kolorektalnih tumora, 12-48
meseci nakon prethodne intervencije sa lokalizacijom u različitim segmentima
debelog creva. Metahroni tumori su češći u bolesnika sa inicijalnim multiplim
tumorima nego u bolesnika sa inicijalnim solitarnim kolorektalnim tumorima.
Većina tumora je otkrivena unutar 24 meseci od kolonoskopske polipektomije
ili kolorektalne hirurgije. Predpostavlja se da bi inicijalni uznapredovali
adenomi i maligno alterisani adenomi mogli da budu dodatni rizični faktori
za razvoj metahronih adenoma. Metahroni CRC su otkriveni u 6.47-7.69% metahronih
tumora u bolesnika različitih inicijalnih grupa. Pravilni, kontrolni, kolonoskopski
pregledi posle kolonoskopske polipektomije ili kolorektalne hirurgije zbog
CRC su neophodni. Kontrolne kolonoskopije mogu da otkriju kolorektalne
adenome različitog stepena displastičnih promena, kolonoskopska polipektomija
može da spreči transformaciju adenoma u CRC (adenoma-carcinoma sequence).
U isto vreme, kontrolne kolonoskopije mogu da otkriju metahrone CRC u ranom
stadijumu, kada je posle kolorektalne hirurgije prognoza mnogo bolja nego
nakon operacije uznapredovalih metahronih CRC.
Ključne reči: Metahroni adenom, metahroni kolorektalni karcinom,
kolonoskopija, kolonoskopska polipektomija
