Colorectal polyps can lead to colorectal cancer, and dealing with their recurrence after polypectomy poses a significant clinical challenge. Our objective was to assess the three-year recurrence rate of colorectal polyps and identify the related risk factors in patients referred to Firoozgar Hospital in Tehran.

This cohort study involved 282 patients with histologically verified polyps, out of which 147 underwent a colonoscopic follow-up after three years. Various clinical, demographic, endoscopic, and histopathological factors were examined to identify predictors of recurrence. To evaluate independent associations, logistic regression models were utilized.

In a cohort of 147 monitored patients, the recurrence rate was found to be 30%. Recurrence was significantly related to polyp histology (p=0.002), the level of dysplasia (p=0.001), and adenoma risk classification (p=0.066). The highest rates of recurrence were observed in sessile serrated (75.0%) and tubulovillous (50.0%) polyps. A strong correlation was identified between high-grade dysplasia and a notably increased recurrence rate (62.5% compared to 27.6%). Multivariable logistic regression analysis indicated that polyp type (hyperplastic versus tubular: OR=0.20, 95% CI: 0.05–0.78, p=0.021) and location (ascending colon OR=0.11, p=0.018; sigmoid OR=0.12, p=0.010; rectum OR=0.13, p=0.027) served as independent predictors for recurrence. There were no significant associations found with either gender or age.

A third of the patients had recurrent polyps within a three-year period. Key factors associated with high-risk adenomas were the most significant predictors of recurrence. These results emphasize the necessity for personalized surveillance approaches for Iranian patients following polypectomy, .