Factors predicting occurrence and therapeutic choice in malignant colorectal polyps: a study of 13 years of colonoscopic polypectomy

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.

Factors Predicting Malignant Occurrence and Polyp Recurrence after the Endoscopic Resection of Large Colorectal Polyps: A Single Center Experience

“…Our study results showed that most of the pathologically examined polyps were sessile, LST-NG and LST-G in the group of patients with carcinoma. The predominance of sessile polyps was found in other studies [ 12 , 17 ], in line with our study results. However, a meta-analysis conducted by Hassan et al [ 20 ] revealed the predominance of pedunculated polyps in patients with colorectal polyps; in our study, only 9.3% of patients had pedunculated polyps.…”

“…In the study by Cazacu et al, statistical significance was reported for the mean diameter between benign and malignant polyps [ 12 ], which is similar to our study results, where patients with polyps ≥ 40 mm in size were more frequently diagnosed with carcinoma. Our study results showed that most of the pathologically examined polyps were sessile, LST-NG and LST-G in the group of patients with carcinoma.…”

“…These results are in agreement with our study results, where 57.4% of male patients with mean age of 66.8 years had malignant polyps upon pathological examination. No statistical significance was found between gender or age and carcinoma diagnosis in our study; however, in the study by Cazacu et al [ 12 ], older patients (≥65 years) had a higher rate of carcinoma in comparison to the younger population.…”

“…The results reported by Cazacu et al [ 12 ] showed that the rate of malignancy in colorectal polyps was higher in patients with two or more polyps, patients with polyps larger than 10 mm in size, in polyp types 0-Ip and 0-Isp (according to JNET classification), in lateral spreading lesions (as compared with flat and sessile lesions) and polyps localized on the left-side, as well as in the rectum. Our study results were similar, where hematochezia, polyp size over 40 mm, morphological type LST-NG, type IIB polyps (according to JNET classification) and complicated accessibility were significant predictors of carcinoma development in the univariate logistic regression analysis.…”

“…In 2021. Cazacu et al [ 12 ] performed a retrospective study of patients with colonoscopic polypectomy during a 13-year period; out of 905 patients with colonoscopic polyps, pathological examination showed polyps with malignant cells in 109 patients. The results of this study showed that the frequency of male patients with malignant polyps was similar to the group of patients with benign polyps, and that the mean age of the patients was 62.6 years.…”