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SUMMARY The histopathological features and results of treatment of malignant polyps removed by endoscopic polypectomy from 60 patients are presented. The patients were followed for a minimum of five years. Forty six patients were treated by polypectomy alone as local excision was judged complete and the invasive carcinoma was well or moderately well differentiated. Thirty seven of these patients are alive and well after five years and the remaining nine have died of other causes up to four years later: there was no evidence of recurrence in any of these cases. Fourteen patients underwent a subsequent major surgical resection and residual tumour was found at the site of polypectomy in two cases but regional lymph nodes were not involved. Only one patient from this group with a high grade tumour developed metastases although the operative specimen was free of tumour. Malignant polyps can be successfully treated by polypectomy alone provided both the laboratory techniques of examination and the histopathological criteria are strictly applied.A previous study from this hospital established the histopathological criteria for the selection and treatment of early cancers of the distal colon and rectum by local excision alone.' Many of these tumours were malignant polyps treated by endoscopic polypectomy using the rigid proctosigmoidoscope, others were small rectal cancers, and a few were lesions treated by colotomy. During the past 10 years there has been rapid development of the techniques of fibre-optic colonoscopy and polypectomy which have eliminated the operation of colotomy and increased the yield of malignant polyps removed by endoscopic methods.Recent reports have challenged the policy of polypectomy alone for malignant polyps of the colorectum which has been established at this hospital during the past 10 years. The object of this paper is to report the pathology and results of treatment of 60 patients followed up for a minimum of five years, of whom 46 were treated by polypectomy alone and 14 by polypectomy and subsequent major surgery. It must be emphasised that these are the results of a prospective study in the sense that it was a deliberate policy to advise

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