Endoscopic Polypectomy and Management of Colorectal Adenomas with Invasive Carcinoma

Abstract

This study supports the view that complete endoscopic polypectomy is an adequate therapy for low-risk carcinoma: A modification of the follow-up regimen, with less frequent endoscopic controls, is justified.

Histologic Risk Factors and Clinical Outcome in Colorectal Malignant Polyp: A Pooled-Data Analysis

“…In those studies for which polyp morphology also could be inferred, a positive resection margin was significantly more frequent in sessile (25/44) than in pedunculated (34/182) polyps (56.8 vs. 18.7 percent; P < 0.0001). 12,14,28,32,33 Local disease was much more frequent in patients with a positive (68/258) than in those with a negative (8/499) margin (26.4 vs. 1.6 percent; odds ratio, 22; 95 percent confidence interval (CI), 10.3-46.6; P < 0.0001; Table 1). Although lymph node localization was similar in the two groups, hematogenous metastasis and cancer-related mortality were significantly more frequent in patients with a positive margin than in those without this risk factor.…”

“…In 23 series, [14][15][16][17][18][19][20][21][22][24][25][26][27]29,[31][32][33][34][35]38,[40][41][42] clinical or endoscopic follow-up data were available, ranging from 12 to 90 (median, 60) months, and accounting for 1,535 (80.1 percent) of the included polyps. Regarding endoscopic data, polyp site was clearly specified in 17 series, accounting for 1,461 polyps.…”

“…Regarding endoscopic data, polyp site was clearly specified in 17 series, accounting for 1,461 polyps. 14,[20][21][22]24,26,27,29,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]39 In such studies, the rectum was involved in 19.6 percent of the cases, the left colon in 71 percent, and the right colon in the remaining 9.4 percent. Polyp morphology was available in 19 series, enrolling 1,145 polyps.…”

“…Death because of surgical complications, inferred from 28 studies, was reported in 8 (0.8 percent) of 951 operated patients. [12][13][14][15][16][17][18][19][20][21][24][25][26][27][28][29][30][31][32][33][34][36][37][38][39][40][41][42] …”

“…[12][13][14][16][17][18][19]21,[27][28][29][30][31][32][33][34]37,[40][41][42] According to our protocol, the resection margin was reported to be positive in 325 (33.2 percent) and negative in the remaining 655 (66.8 percent) cases. In those studies for which polyp morphology also could be inferred, a positive resection margin was significantly more frequent in sessile (25/44) than in pedunculated (34/182) polyps (56.8 vs. 18.7 percent; P < 0.0001).…”