Management of high and low risk malignant polyps: a population‐wide analysis

Abstract

Aim The management of malignant polyps is a treatment dilemma in selecting between polypectomy and colorectal resection. To assist clinicians, guidelines have been developed by the Association of Coloproctology of Great Britain and Ireland (ACPGBI) to provide treatment recommendations. Methods This study compared management strategy based on the ACPGBI risk categorization for malignant polyps. Univariable and multivariable statistical analysis was undertaken to assess the factors predicting management strategy. A population‐wide analysis was performed of 1646 malignant polyps and the factors that predicted their management strategy, from Queensland, Australia, from 2011 to 2019. Results Overall, 31.55% of patients with very low or low risk disease proceeded to resection. Of those with high or very high risk disease, 36.69% did not proceed to resection. In very low and low risk polyps, age (P = 0.003) and polyp location (P < 0.001) were significantly different between the colorectal resection group and the polypectomy alone group. In those with very high or high risk polyps age (P < 0.001), type of facility (public or private) for the colonoscopy (P = 0.037), right colonic polyps compared to left colonic polyps (P = 0.015) and rectal polyps (P < 0.001) and mismatch repair mutations present (P = 0.027) were predictive of resection in high risk disease using a multivariable model. Conclusion Over 30% of patients with very low and low risk malignant polyps proceeded to resection, against the advice of guidelines. Furthermore, over 35% of patients with very high or high risk malignant polyps did not proceed to resection. Education strategies may improve management decision choices. Furthermore, improvements in data collation will improve the understanding of management choices in the future.

Malignant polyps in the COVID‐19 era: a population‐based analysis

“…This study represents one of the largest studies of malignant polyps, and the largest population-complete study of malignant polyps. 1,2 Furthermore, this is the first known study of malignant polyps containing data from 2020 and specifically examining the impact of the COVID-19 pandemic. Over time, there has been an increase in the numbers of malignant polyps diagnosed in Queensland, and this was illustrated with the development of a linear regression model shown in Figure 1.…”

“…1 Following macroscopically complete polypectomy, traditionally all malignant polyps were managed with colorectal resection, however only a minority of colorectal resection specimens contained residual disease in the bowel wall or metastatic lymphatic disease. 2 Pathological factors which describe the risk of residual or lymphatic disease have been incorporated into numerous guidelines, including those from the Association of ColoProctology of Great Britain and Ireland (ACPGBI). 3 December 31st 2019, saw the World Health Organization Country Office in China alerted regarding a cluster of viral pneumonia cases in Wuhan.…”

“…A review of all malignant polyps from January 2011 until October 2019 in Queensland, Australia, has already been published. 2 This study sought to identify how the COVID-19 pandemic during 2020 affected the number of patients being diagnosed with a malignant polyp in Queensland, Australia.…”

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

“…The choice of management strategy is likely to be influenced by patient age and comorbidities. Advancing age [2] and poorer health [7] increase the risk of major colorectal surgery, thus polypectomy alone may become the preferred management strategy in older and more comorbid patients. This potentially introduces a selection bias, as this cohort of patients, with advanced age and comorbidities, is at increased mortality risk.…”

“…A malignant polyp is defined as an endoluminally resected polyp that contains a focus of adenocarcinoma. The adenocarcinoma invades into the submucosa, but not beyond, thereby restricting malignant colorectal polyps to T1 disease only [1,2].…”