Long-term survival after treatment of malignant colonic polyps

Abstract

Treatment of patients with malignant polyps must be individualized based on evolving criteria. Patients in whom polypectomy margins are inadequate should undergo colectomy. With appropriate selection criteria, patients selected for colectomy had a five-year survival rate similar to the rate of those treated by polypectomy alone.

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

“…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.…”

“…Polyp morphology was available in 19 series, enrolling 1,145 polyps. 1 [39][40][41][42] Finally, cancerrelated death was reported in 56 (3.6 percent) of those 1,535 patients for whom follow-up data were available, with an interval from the diagnosis ranging from 5 to 101 (median, 32) months. Death because of surgical complications, inferred from 28 studies, was reported in 8 (0.8 percent) of 951 operated patients.…”

“…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).…”

“…12,20,21,26,28,32,33,35 From 13 studies, it was apparent that the majority of patients with such a risk factor (56/60) underwent surgical resection compared with only 336 of the 739 without it (93.3 vs. 45.4 percent; P < 0.0001). 12,17,18,20,[26][27][28][29]33,37,38,41,42 In addition, patients with areas of poor differentiation had a substantially higher risk of both metastatic disease and cancer-related mortality compared with their counterparts (Table 1).…”