Is Endoscopic Polypectomy an Adequate Therapy for Malignant Colorectal Adenomas? Presentation of 114 Patients and Review of the Literature

Abstract

For patients with low-risk malignant polyps, endoscopic polypectomy alone seems to be adequate. In high-risk patients, the risk of adverse outcome should be weighed against the risk of surgery.

Análise dos pólipos colorretais em 3.491 videocolonoscopias

“…Não é possível determinar quais adenomas evoluirão para câncer, todavia alguns fatores estão ligados a um maior risco de malignização, como histologia vilosa, tamanho maior das lesões e presença de atipias acentuadas 6, 9, 18 . Seitz et al 25 descreveram uma variação na taxa de malignização entre 2 e 9,4%, taxa essa descrita por Bond 24 entre 4 e 7% e por Schmiegel et al 14 de 5%. Ballegooijen et al 19 comprovaram que pacientes portadores de adenomas apresentavam de 0,2 a 1,3 vezes mais chances de desenvolver câncer colorretal.…”

Oncological outcomes after endoscopic removal of malignant colorectal polyps

“…Patients in whom margins could not be conclusively determined had the same incidence of residual disease as patients with positive margins (13). However, whether the requisite distance should be > 1, > 2, or > 3 mm or only a clear margin is still under debate (21,(25)(26)(27). In our analysis we found a 25 % rate of local wall disease and the margin status showed to be an independent risk factor for that, mostly in sessile lesions that are our main group, in agreement with earlier studies as Hassan et al pointed out (22,28,29).…”

Quality assurance in colonoscopy for colorectal cancer diagnosis

“…Polyp resection can be considered to be complete, if the resection margins (both lateral and deep) are free of cancer, if there is no histological evidence of vascular or lymphatic invasion and if there is no poor differentiation on histology. After complete endoscopic resection, the risk of residual or recurrent cancer after polypectomy is less than the risk of surgery due to complications and may even be more cost effective (48)(49)(50) However, polyp recurrence after piecemeal removal of large adenomas is reported to be high, due to the presence of remnants after incomplete removal (51,52). It is advisable to tattoo the polypectomy site and biopsy the scar after 3 to 6 months and 1 year after resection (51)(52) 12.…”