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Roji AM, Namiq KF, Radley S, Ismail T, Hejmadi R, Taniere P, Geh JI. Management of small (T1-T2) anal margin squamous cell carcinoma: clinical outcomes following local excision alone. Colorectal Dis 2023; 25:1403-1413. [PMID: 37029622 DOI: 10.1111/codi.16562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/28/2023] [Accepted: 03/08/2023] [Indexed: 04/09/2023]
Abstract
AIM Squamous cell carcinomas of the anus are normally treated with synchronous chemoradiotherapy (CRT). Small, localized anal margin tumours may be adequately treated by local excision (LE) alone. This study aims to investigate the outcomes of patients with anal margin tumours treated with LE alone, reserving the use of CRT for salvage on local recurrence (LR). METHODS Patients with small, localized (stage I/IIA) anal margin tumours treated by LE from October 1999 to September 2018 were identified. The effect of tumour size and resection margin on LR risk was analysed. Outcomes of overall survival and disease-free survival were measured. RESULTS Fifty-five patients with anal margin tumours were identified. Overall 5-year LR, overall survival and disease-free survival rates were 8%, 86% and 82% respectively. Of the seven LRs, five were successfully salvaged with CRT with no further recurrence and two were not fit for CRT. Resection margins in non-fragmented tumours and tumour size did not significantly influence LR risk. CONCLUSIONS Most small, localized anal margin tumours can be adequately treated by LE alone with low LR rates. Most patients who developed LR were salvaged using CRT, with no cancer-related deaths reported.
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Affiliation(s)
- A M Roji
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - K F Namiq
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - S Radley
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - T Ismail
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - R Hejmadi
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - P Taniere
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - J I Geh
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- School of Cancer Sciences, University of Birmingham, Birmingham, UK
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Factors Predicting Malignant Occurrence and Polyp Recurrence after the Endoscopic Resection of Large Colorectal Polyps: A Single Center Experience. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58101440. [PMID: 36295600 PMCID: PMC9611189 DOI: 10.3390/medicina58101440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/05/2022] [Accepted: 10/08/2022] [Indexed: 12/24/2022]
Abstract
Background: The aim of this study was to identify risk factors contributing to the malignancy of colorectal polyps, as well as risk factors for recurrence after the successful endoscopic mucosal resection of large colorectal polyps in a referral center. Materials and Methods: This retrospective cohort study was performed in patients diagnosed with large (≥20 mm diameter) colorectal polyps and treated in the period from January 2014 to December 2019 at the University Hospital Medical Center Bezanijska Kosa, Belgrade, Serbia. Based on the endoscopic evaluation and classification of polyps, the following procedures were performed: en bloc resection, piecemeal resection or surgical treatment. Results: A total of 472 patients with large colorectal polyps were included in the study. The majority of the study population were male (62.9%), with a mean age of 65.7 ± 10.8 years. The majority of patients had one polyp (73.7%) less than 40 mm in size (74.6%) sessile morphology (46.4%), type IIA polyps (88.2%) or polyps localized in the descending colon (52.5%). The accessibility of the polyp was complicated in 17.4% of patients. En bloc resection was successfully performed in 61.0% of the patients, while the rate of piecemeal resection was 26.1%. Due to incomplete endoscopic resection, surgery was performed in 5.1% of the patients, while 7.8% of the patients were referred to surgery directly. Hematochezia (p = 0.001), type IIB polyps (p < 0.001) and complicated polyp accessibility (p = 0.002) were significant independent predictors of carcinoma presence in a multivariate logistic regression analysis. Out of the 472 patients enrolled in the study, 364 were followed after endoscopic resection for colorectal polyp recurrence, which was observed in 30 patients (8.2%) during follow-up. Piecemeal resection (p = 0.048) and incomplete resection success (p = 0.013) were significant independent predictors of polyp recurrence in the multivariate logistic regression analysis. Conclusions: Whenever an endoscopist encounters a complex colorectal lesion (i.e., a polyp with complicated accessibility), polyp size > 40 mm, the Laterally Spreading Tumor nongranular (LST-NG) morphological type, type IIB polyps or the presence of hematochezia, malignancy risk should be considered before making the decision to either resect, refer to an advanced endoscopist or perform surgery.
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Gijsbers KM, van der Schee L, van Veen T, van Berkel AM, Boersma F, Bronkhorst CM, Didden PD, Haasnoot KJ, Jonker AM, Kessels K, Knijn N, van Lijnschoten I, Mijnals C, Milne AN, Moll FC, Schrauwen RW, Schreuder RM, Seerden TJ, Spanier MB, Terhaar Sive Droste JS, Witteveen E, de Vos tot Nederveen Cappel WH, Vleggaar FP, Laclé MM, ter Borg F, Moons LM. Impact of ≥ 0.1-mm free resection margins on local intramural residual cancer after local excision of T1 colorectal cancer. Endosc Int Open 2022; 10:E282-E290. [PMID: 35836740 PMCID: PMC9274442 DOI: 10.1055/a-1736-6960] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/15/2021] [Indexed: 02/07/2023] Open
Abstract
Background and study aims A free resection margin (FRM) > 1 mm after local excision of a T1 colorectal cancer (CRC) is known to be associated with a low risk of local intramural residual cancer (LIRC). The risk is unclear, however, for FRMs between 0.1 to 1 mm. This study evaluated the risk of LIRC after local excision of T1 CRC with FRMs between 0.1 and 1 mm in the absence of lymphovascular invasion (LVI), poor differentiation and high-grade tumor budding (Bd2-3). Patients and methods Data from all consecutive patients with local excision of T1 CRC between 2014 and 2017 were collected from 11 hospitals. Patients with a FRM ≥ 0.1 mm without LVI and poor differentiation were included. The main outcome was risk of LIRC (composite of residual cancer in the local excision scar in adjuvant resection specimens or local recurrence during follow-up). Tumor budding was also assessed for cases with a FRM between 0.1 and 1mm. Results A total of 171 patients with a FRM between 0.1 and 1 mm and 351 patients with a FRM > 1 mm were included. LIRC occurred in five patients (2.9 %; 95 % confidence interval [CI] 1.0-6.7 %) and two patients (0.6 %; 95 % CI 0.1-2.1 %), respectively. Assessment of tumor budding showed Bd2-3 in 80 % of cases with LIRC and in 16 % of control cases. Accordingly, in patients with a FRM between 0.1 and 1 mm without Bd2-3, LIRC was detected in one patient (0.8%; 95 % CI 0.1-4.4 %). Conclusions In this study, risks of LIRC were comparable for FRMs between 0.1 and 1 mm and > 1 mm in the absence of other histological risk factors.
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Affiliation(s)
- Kim M. Gijsbers
- Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands,Department of Gastroenterology & Hepatology, Deventer Hospital, Deventer, The Netherlands
| | - Lisa van der Schee
- Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tessa van Veen
- Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Femke Boersma
- Department of Gastroenterology & Hepatology, Gelre Hospital, Apeldoorn, The Netherlands
| | | | - Paul D. Didden
- Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Krijn J.C. Haasnoot
- Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anne M. Jonker
- Department of Pathology, Gelre Hospital, Apeldoorn, The Netherlands
| | - Koen Kessels
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Department of Gastroenterology & Hepatology, St. Antonius Hospital, Nieuwegein,
The Netherlands
| | - Nikki Knijn
- Pathology-DNA, Rijnstate Hospital, Arnhem, The Netherlands
| | | | - Clinton Mijnals
- Department of Pathology, Amphia Hospital, Breda, The Netherlands
| | - Anya N. Milne
- Pathology-DNA, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Freek C.P. Moll
- Department of Pathology, Isala Clinics, Zwolle, The Netherlands
| | - Ruud W.M. Schrauwen
- Department of Gastroenterology & Hepatology, Bernhoven, Uden, The Netherlands
| | - Ramon-Michel Schreuder
- Department of Gastroenterology & Hepatology, Catharina Hospital, Eindhoven, The Netherlands
| | - Tom J. Seerden
- Department of Gastroenterology & Hepatology, Amphia Hospital, Breda, The Netherlands
| | - Marcel B.W.M. Spanier
- Department of Gastroenterology & Hepatology, Rijnstate Hospital, Arnhem, The Netherlands
| | | | - Emma Witteveen
- Department of Pathology, Noordwest Hospital, Alkmaar, The Netherlands
| | | | - Frank P. Vleggaar
- Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Miangela M. Laclé
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank ter Borg
- Department of Gastroenterology & Hepatology, Deventer Hospital, Deventer, The Netherlands
| | - Leon M.G. Moons
- Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
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Cazacu SM, Săftoiu A, Iordache S, Ghiluşi MC, Georgescu CV, Iovănescu VF, Neagoe CD, Streba L, Caliţa M, Burtea ED, Cârţu D, Leru PM. Factors predicting occurrence and therapeutic choice in malignant colorectal polyps: a study of 13 years of colonoscopic polypectomy. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2021; 62:917-928. [PMID: 35673811 PMCID: PMC9289694 DOI: 10.47162/rjme.62.4.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Colorectal carcinoma represents a major cause of mortality and 0.2–12% of resected colonic polyps have malignant cells inside. We performed a retrospective study of patients with resected polyps during a period of 13 years. A total of 905 patients had 2033 polyps removed; 122 polyps (109 patients) had malignant cells. Prevalence of malignant polyps with submucosal invasion was 1.23% and for all polyps with malignant cells was 6%; malignant polyps had a larger size (23.44 mm mean diameter) vs benign polyps (9.63 mm); the risk of malignancy was increased in polyps larger than 10 mm, in lateral spreading lesions and in Paris types 0-Ip, 0-Isp, in sigmoid, descending colon and rectum, in sessile serrated adenoma and traditional serrate adenoma subtypes of serrated lesions and in tubulovillous and villous adenoma. In 18 cases surgery was performed, in 62 patients only colonoscopic follow-up was made and in 35 patients no colonoscopic follow-up was recorded. From initially endoscopic resected polyps, recurrence was noted in seven (11.3%) cases; there was a trend toward association with depth of invasion, piecemeal resection, right and rectum location, sessile and lateral spreading type and pathological subtype. In surgical group, post-therapeutic staging was available in 11 cases; nodal involvement was noted in three (27.27%) cases; none had lymphatic or vascular invasion in endoscopically resected polyps. Four patients with no macroscopic local recurrence underwent surgery with no residual tumor. The rate of metastasis was 16.67% in surgical group and 1.61% in endoscopic group. Evaluation of lymph node (LN) invasion was available for 11 operated patients, with LN invasion (N1) in three patients, local residual tumoral tissue in one patient with incomplete resection and no residual tumor (R0 resection) in four patients with endoscopic resection before surgery.
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Affiliation(s)
- Sergiu Marian Cazacu
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, Romania; ,
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Increased Rate of Incidental Colorectal Malignant Polyps: A Single-Center Experience. Surg Res Pract 2018; 2018:3465931. [PMID: 29850648 PMCID: PMC5937378 DOI: 10.1155/2018/3465931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 02/28/2018] [Accepted: 03/11/2018] [Indexed: 12/04/2022] Open
Abstract
Background and Aims To investigate the incidence and treatment of colorectal malignant polyps before and after colorectal cancer screening initiation in March 2014 in a single Danish center. Materials and Methods 71 patients with colorectal malignant polyps in a single center from 2012 to 2015 were reported retrospectively. Results There was a significant increase (P < 0.01) in the incidence of colorectal malignant polyps from 2012 to 2013 and 2014 to 2015 (8 versus 63) relative to the increase in colonoscopies with polypectomy (1029 versus 2706). It coincides with the initiation of screening in March 2014. A positive, nonradical, or undeterminable resection margin was found in 57% (36/63), and this was the primary indication for surgery. Additional surgery was done in 49% of the cases (31/63) with 27 bowel resections and 4 transanal endoscopic microsurgery (TEM) procedures. Nineteen percent (5/27) had either residual cancer cells at the polypectomy site or lymph node metastasis in the resection specimens. Conclusion Colorectal malignant polyps have become more frequent after the initiation of screening. The primary, and operator-dependent, indicator for surgery is the positive, nonradical, or undeterminable resection margin, and 1 in 5 operated has remaining cancer in the resection specimens.
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Abstract
Most polyps that originate in the colon and rectum are benign. A small subset of polyps will contain a malignancy. Although most malignant adenomas are managed with colonic resection a number can be approached with endoscopic, minimally invasive, and observational techniques. This article reviews the histologic characteristics and adverse risk factors that would portend a poor oncologic outcome and therefore suggest formal colonic resection. Modern endoscopic techniques such as endoscopic mucosal resection and endoscopic submucosal resection are discussed.
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Affiliation(s)
- Jason F Hall
- Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts ; Department of Surgery, Tufts University School of Medicine, Boston, Massachusetts
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Fasoli R, Nienstedt R, De Carli N, Monica F, Guido E, Valiante F, Armelao F, de Pretis G. The management of malignant polyps in colorectal cancer screening programmes: A retrospective Italian multi-centre study. Dig Liver Dis 2015; 47:715-9. [PMID: 25986044 DOI: 10.1016/j.dld.2015.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 04/04/2015] [Accepted: 04/18/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although recognition of colorectal malignant polyps is increasing, treatment plans lack the evidence of randomised trials. AIM To retrospectively evaluate presentation, management and outcomes of screen-detected colorectal malignant polyps, with special focus on the role of histological factors in therapeutic decision-making. METHODS We retrospectively analysed data regarding malignant polyps detected during faecal immuno-chemical test-based screening programmes in five centres in North-Eastern Italy between April 2008 and April 2013. RESULTS 306 malignant polyps in 306 patients were included; 72 patients underwent surgery directly (23.6%). Of 234 patients treated endoscopically, 133 subsequently underwent radicalisation surgery (56.8%) and in 17 there was evidence of residual disease (12.8%). Involved, unsafe (<1mm) or invaluable resection margins and sessile morphology represented the most frequent determinants of subsequent surgery. The mean number of nodes harvested during radicalisation surgery was 7.1±6.4 (range 0-29). Histological diagnosis was re-evaluated according to new guidelines in 125 cases (41%); in 18 this led to modification of the risk class (14.4%). CONCLUSIONS Although the rate of surgical treatment following endoscopic resection is similar to other studies, residual disease at surgery was lower than most international series. Adhering to the new histological reporting system and respecting guidelines on node harvesting may favourably influence prognosis.
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Affiliation(s)
- Renato Fasoli
- Provincial Department of Gastroenterology and Digestive Endoscopy, Santa Chiara Hospital, Trento, Italy.
| | - Richard Nienstedt
- Provincial Department of Gastroenterology and Digestive Endoscopy, Santa Chiara Hospital, Trento, Italy
| | | | - Fabio Monica
- Gastroenterology and Digestive Endoscopy Unit, Bassano del Grappa Hospital, Bassano del Grappa, VI, Italy
| | - Ennio Guido
- Gastroenterology and Digestive Endoscopy Unit, Sant'Antonio Hospital, Padova, Italy
| | - Flavio Valiante
- Gastroenterology and Digestive Endoscopy Unit, Santa Maria del Prato Hospital, Feltre, BL, Italy
| | - Franco Armelao
- Provincial Department of Gastroenterology and Digestive Endoscopy, Santa Chiara Hospital, Trento, Italy
| | - Giovanni de Pretis
- Provincial Department of Gastroenterology and Digestive Endoscopy, Santa Chiara Hospital, Trento, Italy; Provincial Department of Gastroenterology and Digestive Endoscopy, Santa Maria del Carmine Hospital, Rovereto, TN, Italy
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Wang LM, Guy R, Fryer E, Kartsonaki C, Gill P, Hughes C, Szuts A, Perera R, Chetty R, Mortensen N. The Ueno method for substaging pT1 colorectal adenocarcinoma by depth and width measurement: an interobserver study. Colorectal Dis 2015; 17:674-81. [PMID: 25620664 DOI: 10.1111/codi.12910] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 10/25/2014] [Indexed: 02/08/2023]
Abstract
AIM Early pT1 polyp colorectal cancers (CRCs) present challenges for accurate pathology substaging. Haggitt and Kikuchi stages depend on polyp morphology and are often difficult to apply due to suboptimal orientation or fragmentation, or absence of the muscularis propria in polypectomy or submucosal resection specimens. European guidelines for quality assurance suggest using Ueno's more objective approach, using depth and width measurements beyond muscularis mucosae. We have investigated interobserver variation using Ueno's approach. METHOD Ten consecutive pT1 polyp CRCs were identified and the slides assessed by six gastrointestinal pathologists for depth and width of invasion. A further 60 polyps were studied by a group of specialist and general pathologists. Agreement was assessed by analysis of variance. A polyp CRC is classified as high risk if it has a depth ≥ 2000 μm or a width ≥ 4000 μm and low risk with a depth < 2000 μm or a width < 4000 μm. Concordance for the dichotomized values was assessed using the kappa statistic. RESULTS The intraclass correlation coefficient (ICC) for depth was 0.83 and for width 0.56 in the 10-polyp group. The ICC for the 60-polyp CRCs was 0.67 for depth and 0.37 for width. In both groups, when polyp CRCs are divided into high- and low-risk categories based on depth, there was substantial and moderate agreement (κ = 0.80 and 0.47) but only fair agreement when based on width (κ = 0.34 and 0.35). CONCLUSION Ueno's method has the advantage of being independent of polyp morphology. Our study shows better concordance for depth measurement and reproducibility in nonfragmented specimens, with poorer agreement when based on width.
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Affiliation(s)
- L M Wang
- Department of Cellular Pathology, John Radcliffe Hospital, University of Oxford, Headington, Oxford, UK
| | - R Guy
- Department of Colorectal Surgery, Churchill Hospital, University of Oxford, Headington, Oxford, UK
| | - E Fryer
- Department of Cellular Pathology, John Radcliffe Hospital, University of Oxford, Headington, Oxford, UK
| | - C Kartsonaki
- CR-UK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, John Radcliffe Hospital, University of Oxford, Headington, Oxford, UK
| | - P Gill
- Department of Cellular Pathology, John Radcliffe Hospital, University of Oxford, Headington, Oxford, UK
| | - C Hughes
- Department of Cellular Pathology, John Radcliffe Hospital, University of Oxford, Headington, Oxford, UK
| | - A Szuts
- Department of Cellular Pathology, John Radcliffe Hospital, University of Oxford, Headington, Oxford, UK
| | - R Perera
- Department of Cellular Pathology, John Radcliffe Hospital, University of Oxford, Headington, Oxford, UK
| | - R Chetty
- Department of Cellular Pathology, John Radcliffe Hospital, University of Oxford, Headington, Oxford, UK
| | - N Mortensen
- Department of Colorectal Surgery, Churchill Hospital, University of Oxford, Headington, Oxford, UK
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Management of sessile malignant polyps: is colonoscopic polypectomy enough? Surg Endosc 2014; 29:2947-52. [PMID: 25537379 DOI: 10.1007/s00464-014-4027-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 11/24/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND The role of endoscopy in the management of malignant-pedunculated polyps has been well studied, but endoscopic management of malignant sessile polyps has not. Sometimes patients with malignant sessile polyps have comorbidities that make surgery exceptionally risky, and endoscopy beckons as a definitive management option. The aim of this study is to evaluate the potential role of endoscopy in the management of malignant sessile polyps. METHODS Patients undergoing colonoscopic polypectomy for malignant sessile polyps by a single endoscopist from 1997 to 2010 were evaluated. Demographic data, clinicopathological variables as well as long-term outcomes were recorded. RESULTS Sixteen patients had malignant sessile polyps. Six (37.5 %) were male and 10 (62.5 %) were female. Mean age at diagnosis was 72.9 ± 12.2 years. Six polyps were proximal to the splenic flexure (37.5 %) and 10 (62.5 %) were distal. The mean size of the polyps was 30.5 ± 15.9 mm. All polyps were removed endoscopically but 7 patients (43.8 %) had formal colectomy following colonoscopic resection. There were no demographic differences between patients with and without surgery. Piecemeal polypectomy was necessary in 8 patients, 4 from the surgery group, and 4 from the endoscopy group. More patients in the surgery group had poorly differentiated cancers (4/6 vs. 0/6) and incomplete margins (5/6 vs. 1/6) and more patients in the endoscopically treated group had serious comorbidity (5/9 vs. 3/7). There was no procedure-related morbidity or mortality. After a mean follow-up of 48.4 ± 27.2 months, one patient from the polypectomy group patient had a local recurrence and a liver metastasis, after originally declining surgery. In the surgery group, one patient had lung metastasis. The two patients who recurred with distant metastasis died. CONCLUSION Endoscopic management of sessile colorectal polyps appears to be feasible and safe in patients with well/moderately differentiated cancer and negative margins. Larger studies are needed to confirm these findings.
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Francisco LK. Actualizaciones en el diagnóstico y tratamiento quirúrgico de los pacientes con cáncer de colon. REVISTA MÉDICA CLÍNICA LAS CONDES 2013. [DOI: 10.1016/s0716-8640(13)70203-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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