Year 2025 / Volume 117 / Number 12
Original
Uncovering missed opportunities - A root-cause analysis of post-colonoscopy colorectal cancer in a tertiary care setting

730-736

DOI: 10.17235/reed.2025.11320/2025

Jorge Ruiz-Rodríguez, Carolina Román de la Fuente, María Ángeles Torres Nieto, Paula Bayo Juanas, Isabel Ruiz Núñez, Cristina Martínez Cuevas, Alicia Sanjosé Crespo, Pilar Díez Redondo, Francisco Javier García-Alonso,

Abstract
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
Lay Summary
Colorectal cancer (CRC) is a common and serious disease, but it can often be prevented through colonoscopy by identifying and removing precancerous lesions. However, in some cases, cancer still develops after a colonoscopy that fails to detect abnormalities. These cases are known as post-colonoscopy colorectal cancers (PCCRCs). Understanding why this happens can help improve colonoscopy quality. In this study, we reviewed the medical records of patients diagnosed with CRC at our hospital between 2018 and 2022. We looked at how many colonoscopies they had before their cancer diagnosis and analyzed those cases to understand why the cancers might have been missed. Out of 660 CRC cases, 55 occurred in patients who had previously undergone a colonoscopy in which no cancer was detected. Most of these cases were due to unidentified lesions or inadequate bowel preparation. In some cases, cancers developed due to the incomplete removal of a previously detected lesion. These missed cancers were more common in the right colon and rectum. Most patients received treatment with curative intent, however, many were diagnosed at an advanced stage. This study highlights the importance of improving colonoscopy practices, particularly by ensuring better bowel preparation and enhancing the detection and complete removal of lesions
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Ruiz-Rodríguez J, Román de la Fuente C, Torres Nieto M, Bayo Juanas P, Ruiz Núñez I, Martínez Cuevas C, et all. Uncovering missed opportunities - A root-cause analysis of post-colonoscopy colorectal cancer in a tertiary care setting. 11320/2025


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Publication history

Received: 04/05/2025

Accepted: 26/06/2025

Online First: 04/07/2025

Published: 12/12/2025

Article Online First time: 61 days

Article editing time: 222 days


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