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To analyse the frequency, characteristics and diagnosis of synchronic neoplastic lesions in colorectal cancer. A review was carried out of 384 colorectal cancers, diagnosed through complete colonoscopy and resected. The synchronic cancers and the characteristics of the adenomas were determined: number, size, histological type, dysplasia, as well as their localisation in the colon and with respect to the carcinoma. Twenty-eight synchronic cancers were found (7.3% of the total); 8 developed tumours and 20 malignant polyps. In 54.4% of the cases there was a synchronic adenoma. In patients with synchronic lesions, 43% showed an advanced adenoma. Twenty percent of the synchronic polyps found were proximal to the splenic flexure; 41% were distal and 38% had both localisations. Fifty-nine point one percent of the patients had some adenoma proximal to the cancer, with criteria of advanced adenoma in 13.9%. The distribution of the adenomas was more uniformly spread in the cancers with a proximal localisation (p = 0.038). Seventeen percent of the distal cancers presented synchronic lesions with a proximal colon localisation exclusively. Partial endoscopies would diagnose the distal cancers, but would omit a synchronic adenoma in 42.3% of the sigmoidoscopies and 40% of the short colonoscopies. High rates of carcinoma and synchronic adenomas were registered. We underline the high index of advanced adenomas and the frequency of synchronic lesions proximal to the cancer, which is why incomplete colonoscopies, although allowing the diagnosis of the distal cancer, omit a high percentage of synchronic adenomas, including advanced lesions. All of this confirms the need to perform a complete pre- , intra- and post operational colonoscopy in resectable colorectal cancer.

Objetivo: en el cáncer colorrectal son poco conocidas las causas del frecuente desarrollo de lesiones neoplásicas sincrónicas. Pretendemos identificar posibles factores que pudieran influir en la multicentricidad lesional. Su conocimiento sería útil para, tras el tratamiento de las lesiones iniciales, optimizar el seguimiento en los pacientes que los presentaran. Pacientes y métodos: estudiamos retrospectivamente 382 cánceres colorrectales diagnosticados mediante colonoscopia completa y estudio de la pieza quirúrgica. Comparamos una serie de parámetros referentes a los antecedentes personales y familiares, hábitos, datos clínicos y del tumor entre los grupos con y sin lesiones neoplásicas sincrónicas, mediante análisis estadístico univariable y multivariable. Resultados: doscientos ocho (54,5%) pacientes presentaron adenomas sincrónicos y 28 (7,3%) carcinoma sincrónico. En el análisis multivariable el sexo masculino: OR = 1,97; IC = 1,13-3,45, p = 0,017; la edad superior a 59 años: OR = 2,57; IC = 1,54-4,29, p < 0,001; el antecedente personal de pólipo colónico: OR = 3,04, IC = 1,04-8,85, p = 0,042 y el carácter obstructivo del cáncer: OR = 0,48; IC = 0,27-0,85, p = 0,012 se asocian significativamente con la multicentricidad lesional. Conclusión: en los enfermos con cáncer colorrectal, nuestro estudio muestra una serie de parámetros, de fácil determinación, que podrían comportarse como factores de riesgo para el desarrollo de multicentricidad lesional. Estos factores deberán confirmarse mediante un estudio de seguimiento, analizando su comportamiento entre los pacientes que presenten o no lesiones metacrónicas tras la limpieza quirúrgico-endoscópica inicial.