Management of the colorectal polyp referred for resection: A case-matched comparison of advanced endoscopic surgery and laparoscopic colectomy

Gamaleldin, Maysoon; Benlice, Çiğdem; Delaney, Conor P.; Steele, Scott R.; Görgün, Emre

doi:10.1016/j.surg.2017.10.057

Cited by 32 publications

(35 citation statements)

References 14 publications

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“…For sessile polyps larger than 20 mm without features of malignancy, ESD should be considered as first line treatment which serves both diagnostic and therapeutic purposes. Gamaleldin et al conducted a case-matched study comparing the outcomes of patients who underwent ESD with those who underwent laparoscopic colectomy for large benign colorectal polyps, the results showed that ESD had a 43% cost-reduction advantage over laparoscopic colectomy and a 6% lower complication rate (15). Complete resection with clear proximal, distal and circumferential margins is indispensable to enable both precise pathological diagnosis and curative potential (16).…”

Section: Introductionmentioning

confidence: 99%

“…Despite the advances in endoscopic resection techniques for difficult colonic polyps, there is still a subgroup of polyps that are endoscopically unresectable, which has historically been managed by surgical resection. Most studies reported favorable outcomes of laparoscopic resection for endoscopically unresectable benign polyps, operative risks including iatrogenic injury, bleeding, infection, and anastomotic leakage cannot be ignored: whereas the morbidity and mortality rate were reported as 9.3-21% and 0-2.7% respectively (5,15,17).…”

Section: Introductionmentioning

confidence: 99%

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Combined endo-laparoscopic surgery for difficult benign colorectal polyps

Liu¹,

Jiang²,

Chan³

et al. 2020

J Gastrointest Oncol

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Prevention of colorectal cancer (CRC) depends largely on the detection and removal of colorectal polyps. Despite the advances in endoscopic techniques, there are still a subgroup of polyps that cannot be treated purely by endoscopic approach, which comprise of about 10-15% of all the polyps. These so-called "difficult colorectal polyps" are polyps with large size, morphology, at difficult location, scarring or due to recurrence, which have historically been managed by surgical segmental resection. In treating benign difficult colorectal polyps, we have to balance the operative risks and morbidities associated with surgical segmental resection. Therefore, combined endoscopic and laparoscopic surgery (CELS) has been developed to remove this subgroup of difficult benign polyps. We review the currently use of CELS for difficult benign colorectal polyps which includes laparoscopy-assisted endoscopic polypectomy (LACP), full-thickness laparo-endoscopic excision (FLEX) and colonoscopy-assisted laparoscopic wedge resection (CAL-WR).

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Combined endo-laparoscopic surgery for difficult benign colorectal polyps

Liu¹,

Jiang²,

Chan³

et al. 2020

J Gastrointest Oncol

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“…La polipectomía endoscópica es un importante procedimiento con el que cuenta el cirujano como opción terapéutica y ha demostrado disminuir la incidencia de cáncer colorrectal en grandes poblaciones 17 . Su objetivo puede ser primariamente diagnóstico: remoción completa de los pólipos de colon y recto para su diagnóstico histológico definitivo, evaluación y posteriores medidas terapéuticas.…”

Section: Discussionunclassified

“…Un desafío importante lo constituyen los pólipos grandes y difíciles, tanto desde el punto de vista técnico como oncológico, para decidir si deben ser tratados por resección endoscópica ( solo con ansa, mucosectomía o disección endoscópica submucosa), una terapéutica combinada laparoscópica/endoscópica o una resección quirúrgica oncológica típica 2,17 .…”

Section: Introductionunclassified

Pólipos grandes de colon: ¿resección endoscópica o colectomía?

Rodríguez¹,

Argentina²,

Prieto³

2019

Rev Argent Cirug

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Background: Endoscopic polypectomy is an accepted procedure for prevention of colorectal cancer. Yet, large and difficult polyps present a technical and medical challenge to correct treatment. Objective: The aim of this study was to report and analyze the experience in the treatment of large colon polyps. Material and methods: We analyzed the endoscopic resection of large colon polyps performed between January 2006 and March 2018. Results: Of 3397 lower gastrointestinal endoscopies, 22 patients underwent resection of 25 large polyps (0.64%). There were no complications or deaths in the series. Conclusions: Endoscopic resection of large colon polyps is feasible and safe in lesions > 20 mm in diameter. The procedure serves both as biopsy or definite treatment and is an additional tool for the surgeon who has the capability of dealing with the complications or completing with surgery.

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“…The potential risks of laparoscopic resection may outweigh the potential risk of lymph node metastasis if the "difficult" polyps are not resected en bloc. Until now, no important study showed that ESD has better results and outcomes in comparison with surgery [41][42][43][44][45]. For "difficult", endoscopically unresectable rectal polyps, transanal excision is the method of choice.…”

Section: Endoscopic Mucosal Resectionmentioning

confidence: 99%

The “Difficult” Colorectal Polyps and Adenomas: Practical Aspects

Herszényi¹

2018

Dig Dis

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Background: Colonoscopy is the gold standard for adenoma detection. All endoscopists who perform colonoscopy must by mandate be skilled to perform polypectomy. However, there are significant differences between endoscopists in terms of the polyp detection rate and in the effectiveness of polypectomy. Summary: Most polyps identified can be managed by conventional polypectomy and do not pose a significant challenge for resection to an adequately skilled and trained endoscopist. Up to 15% of polyps may be considered “difficult”, unsuitable for conventional endoscopic removal because of size, morphology, site, or access grade. Endoscopist-, patient- and polyp-specific viewpoints influence the management of difficult polyps. Advances in endoscopic resection techniques have led to extended indications for polypectomy. Conventional endoscopic removal of colorectal polyps is associated with a small but not negligible incidence of complications, most commonly bleeding and perforation. Advanced techniques for difficult polyps can potentially cause significant, even life-threatening complications. In addition, in the presence of “difficult” polyps, complications are more common. Key Messages: Multiple techniques are now available for the resection of difficult polyps. The endoscopist should individualize the appropriate approach for the treatment of difficult polyp in order to maximize oncological safety, efficacy and minimize complications and unnecessary surgery.

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Management of the colorectal polyp referred for resection: A case-matched comparison of advanced endoscopic surgery and laparoscopic colectomy

Cited by 32 publications

References 14 publications

Combined endo-laparoscopic surgery for difficult benign colorectal polyps

Combined endo-laparoscopic surgery for difficult benign colorectal polyps

Pólipos grandes de colon: ¿resección endoscópica o colectomía?

The “Difficult” Colorectal Polyps and Adenomas: Practical Aspects

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