In comparison with polypectomy, colorectal resection is associated with improved survival for patients diagnosed with malignant polyps

Abstract

Aim Patients diagnosed with a malignant polyp generally have favourable overall survival (OS) and cancer‐specific survival (CSS). However, it is unclear how choice in management for malignant polyps may affect survival. Methods Data from the Queensland Oncology Repository was analysed to derive a population wide assessment of the impact of management strategy on OS and CSS for patients diagnosed with malignant polyps. Log‐rank testing, Kaplan–Meier and Cox‐regression models were performed. Patients were matched using propensity score and Mahalanobis distance matching. Results A total of 1,646 patients were included with 240 deaths and 52 colorectal cancer related deaths until censor date. Following propensity score and Mahalanobis distance matching of patients undergoing polypectomy alone versus colorectal resection, there was no significant difference in the age groups (<60 years of age or ≥60 years of age), American Society of Anesthesiology score, comorbidity count or Association of ColoProctology of Great Britain and Ireland risk category. However, of note Log‐rank testing demonstrated a significant difference in OS (p < 0.001) and CSS (p = 0.0061) between management strategies. Multivariable Cox‐regression models in matched and un‐matched patient cohorts demonstrated significantly lower hazards of death for OS with resection (p < 0.001). However, CSS was no longer significantly different between management groups in multivariable Cox‐regression analysis (p = 0.073). Conclusion Patients who underwent colorectal resection had significantly improved OS and CSS compared with polypectomy alone. Improved OS was furthermore seen on multivariable analysis, and in matched cohorts. Future research should investigate why this unexpected finding may be the case and whether updates to guidelines should be considered.

Estimation of risk posed by malignant polyps amongst colorectal surgeons in Australia and New Zealand

“…It is, therefore, not surprising to see that 96.6% of surgeons responded that a reliable, online risk calculator for malignant polyps would be of use to their clinical practice. Despite the use of the ACPGBI algorithm in clinical practice, a recent analysis of malignant polyps demonstrated that patients undergoing colorectal resection had improved survival over those https://doi.org/10.3393/ac.2023.00178.0025 who underwent polypectomy alone, even amongst the low-risk and very-low-risk polyp groups [23]. Thus, the future development of guidelines, nomograms, or online calculators for malignant polyps should also incorporate the impacts on survival, and not just residual or lymphatic disease.…”

Prognostic Roles and Survival Benefits of Endoscopic Resection Versus Surgical Resection in the Management of Malignant Colon Polyps

“…The management strategy was the most significant predictor of overall and recurrence free survival rates in patients with malignant colon polyps (p < 0.001) (►Figure 2) (►Tables [2][3][4][5][6].…”

“…These polyps correspond to 2 to 5% of all removed polyps. 3 Management of these polyps is still challenging, with two main scenarios of management: either follow-up after the initial endoscopic resection/polypectomy or performing surgical resection/colectomy. It was hypothesized that complete resection of these polyps until reaching a clear safety margin of $ 1 to 2 mm away from the excised edge, good or moderate differentiation of the cancer and absence of lymphovascular invasion, favor performing polypectomy alone, while presence of invaded margins, poorly differentiated carcinoma, presence of lymphovascular invasion, deep submucosal invasion or tumor budding favor performing colon resection.…”