Authors: James M. Church, MD, FACS
Summary:
Background: There is a continuing debate on the best approach for endoscopically benign large polyps that are unsuitable for conventional endoscopic resection. This study aims to estimate the cancer risk in patients with endoscopically benign unresectable colonic polyps referred for surgery.
Study Design: Patients with an endoscopic diagnosis of benign adenoma deemed not amenable for endoscopic removal who underwent colectomy between 1997- 2012 were accessed. Patients with preoperative diagnoses of cancer, inherited polyposis syndrome, inflammatory bowel disease, and synchronous pathology requiring surgery were excluded.
Results: 439 patients [220(50.1%) men; median age 67(27-97) years] underwent colectomy. Of 439 patients, 346(79%) underwent preoperative endoscopy at our institution for all polyps preoperative biopsy was benign. Most of the polyps were located in the right colon (394/439, 89.7%) with majority being in the cecum (199/394, 45.3%). Polyp morphology was as follows: sessile (n=252, 57.4 %), pedunculated (n=109, 24.8%) and flat (n=78, 17.8%). Endoscopic pathology revealed high-grade dysplasia in 88 (20%) patients. Mean colonoscopic and postoperative polyp sizes were 3.0 cm (range, 0.3-10) and 2.7 cm (range, 0-11) cm, respectively (p<0.001). Final surgical pathology revealed cancer in 37 patients (8%). Polyp location, morphology and histologic types were similar between the benign and malignant polyps. Cancer stages were: stage I (23 patients), stage II (11), and stage III (3).
Conclusions: For the majority of endoscopically benign colonic polyps an oncologic colonic resection may be unnecessary hence adaption of advanced endoscopic resection techniques or laparoscopic assisted polypectomy should be considered. When bowel resection is needed, the resection should be performed obeying oncologic principles and techniques.
Source:
Journal of the American College of Surgeons; June 2016