Oncologic Colorectal Resection, Not Advanced Endoscopic Polypectomy, Is the Best Treatment for Large Dysplastic Adenomas

Jang, Joon Ho; Balık, Emre; Kirchoff, Daniel D.; Tromp, Wouter; Kumar, Anjali S.; Grieco, Michael J.; Feingold, Daniel L.; Cekic, Vesna; Njoh, Linda; Whelan, Richard L.

doi:10.1007/s11605-011-1746-9

Cited by 35 publications

(31 citation statements)

References 27 publications

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“…Polyps that have established or even possible development of malignant transformation require a formal oncologic resection with central vascular ligation and lymphadenectomy (11,15,16). In our study, we performed 15 (25.9%) colotomies with mobilization of the colon and polypectomy, and 41 (70.7%) bowel resections.…”

Section: Discussionmentioning

confidence: 96%

Laparoscopic colorectal surgery for colorectal polyps: experience of ten years

Dulskas

Kuliešius

Samalavičius

2017

AML

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Background. Laparoscopy or its combination with endoscopy is the next step for "difficult" polyps. The purpose of the paper was to review the outcomes of the laparoscopic approach to the management of "difficult" colorectal polyps.Materials and methods. From 2006 to 2016, 58 patients who underwent laparoscopic treatment for "difficult" polyps that could not be treated by endoscopy at the National Cancer Institute, Lithuania, were included. The demographic data, the type of surgery, length of post-operative stay, complications, and final pathology were reviewed prospectively.Results. The mean patient was 65.9 ± 8.9 years of age. Laparoscopic mobilization of the colonic segment and colotomy with removal of the polyp was performed in 15 (25.9%) patients, laparoscopic segmental bowel resection in 41 (70.7%) cases: anterior rectal resection with partial total mesorectal excision in 18 (31.0%), sigmoid resection in nine (15.5%), left hemicolectomy in seven (12.1%), right hemicolectomies in two (3.4%), ileocecal resection in two (3.4%), resection of transverse colon in two (3.4%), and sigmoid resection with transanal retrieval of specimen in one (1.7%). Two patients (3.4%) underwent laparoscopicassisted endoscopic polypectomy. The mean post-operative hospital stay was 5.7 ± 2.4 days. There were four complications (6.9%). All patients recovered after conservative treatment. The mean polyp size was 3.5 ± 1.9 cm. Final histopathology revealed hyperplastic polyps (n = 2), tubular adenoma (n = 9), tubulovillous adenoma (n = 31), carcinoma in situ (n = 12), and invasive cancer (n = 4).Conclusions. For the management of endoscopically unresectable polyps, laparoscopic surgery is currently the technique of choice.

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Section: Discussionmentioning

confidence: 96%

Laparoscopic colorectal surgery for colorectal polyps: experience of ten years

Dulskas

Kuliešius

Samalavičius

2017

AML

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“…The rate of unexpected malignancy in endoscopically unresectable colonic polyps undergoing segmental colectomy is around 10% [54][55][56], with a similar rate found in a review of laparoendoscopic colonic polyp surgery [32]. The rate of unexpected malignancy in endoscopically unresectable colonic polyps undergoing segmental colectomy is around 10% [54][55][56], with a similar rate found in a review of laparoendoscopic colonic polyp surgery [32].…”

Section: Discussionmentioning

confidence: 61%

Evaluation of an early‐stage innovation for full‐thickness excision of benign colonic polyps using the IDEAL framework

et al. 2019

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Aims Colectomy is the current approach for patients with endoscopically unresectable benign polyps but risks considerable morbidity. Full-thickness laparoendoscopic excision (FLEX) is a novel procedure, specifically developed to treat endoscopically unresectable benign colonic polyps, which could reduce the treatment burden of the current approach and improve outcomes. However, traditional evaluations of surgical innovations lack methodological rigour. This study reports the development and feasibility of the FLEX procedure in selected patients. ConclusionsThe FLEX procedure is still under development. Early data demonstrate that it is safe for excision of selected benign polyps. Modifications to transcolonic suture delivery are now required and there is a need for wider adoption before more definitive evaluation can be performed. What does this paper add to the literature?This study has shown, through an examination of the feasibility of the full-thickness laparoendoscopic excision (FLEX) procedure for resection of complex, benign colonic polyps in clinical practice, that incorporating the Idea, Development, Evaluation, Assessment, Long-term study (IDEAL) framework guidance can enhance transparency and reduce information bias.

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“…However, this is a known risk when a CELS approach is attempted. Patients must understand that the risk of invasive cancer is roughly 15 % [1] and that a discrepancy may exist between the frozen section and the final pathologic evaluation, which may necessitate a subsequent bowel resection. In fact, the incidence of invasive cancer in this study was 28 % (4/14).…”

Section: Discussionmentioning

confidence: 99%

“…Benign-appearing colonic polyps that cannot be removed by conventional endoscopic techniques typically are referred for surgical resection, mainly due to the risk of cancer, estimated at roughly 15 % in this subset of patients [1]. Although generally safe, a segmental colectomy is associated with risks that include wound infection, anastomotic leak, and stoma formation.…”

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confidence: 99%

Combined endoscopic and laparoscopic surgery may be an alternative to bowel resection for the management of colon polyps not removable by standard colonoscopy

et al. 2013

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Background Benign colon polyps may require bowel resection if endoscopic polypectomy cannot be performed to assess adequately for cancer. However, endoscopic removal still may be possible using combined endoscopic and laparoscopic surgery (CELS). The CELS procedure allows for intra- and extraluminal manipulation of the bowel wall to facilitate polyp removal, thereby avoiding bowel resection. This study evaluated the authors’ institutional experience with CELS in this patient population. Methods Between August 2008 and October 2012, all patients referred to undergo surgery for a benign colon polyp were retrospectively reviewed for operative characteristics, pathology, and postoperative outcomes. Of 14 patients, five were considered candidates for CELS and were compared with nine patients who underwent resection. Results The average patient age was similar between the two groups (CELS, 64.9 years vs. resection, 68.3 years). The mean polyp size was 2.3 cm in the CELS group and 2.9 cm in the resection group. In the CELS group, polyps were successfully removed in all cases. The mean operating room time was 159 min in the CELS group and 205 min in the resection group. The median hospital stay was 1 day in the CELS group and 5 days in the resection group. No complications occurred in the CELS group. Two patients in the resection group (22 %) experienced a wound infection. One patient had a postoperative ileus (11 %). Four patients in the CELS group had a benign adenoma. One patient had a benign frozen section evaluation, but the final pathology showed adenocarcinoma requiring a subsequent colectomy. In the resection group, six patients had a benign adenoma, and three patients had a T1N0 cancer. In the CELS group, repeat endoscopy was performed an average of 9.9 months after CELS. Two patients had a residual polyp, and two patients had new polyps in a different location. All were successfully removed. Conclusion For benign-appearing polyps not amenable to endoscopic techniques alone, CELS may be an alternative to formal bowel resection for carefully selected patients. The CELS procedure can be performed safely with minimal morbidity and with outcomes that compare favorably with those of formal colectomy.

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Oncologic Colorectal Resection, Not Advanced Endoscopic Polypectomy, Is the Best Treatment for Large Dysplastic Adenomas

Abstract: Over one out of three of dysplastic polyps and 10% of adenomas were invasive cancers. OCR is advised for dysplastic polyps; ESD, EMR, and wedge resection are appropriate for non-dysplastic adenomas.

Cited by 35 publications

References 27 publications

Laparoscopic colorectal surgery for colorectal polyps: experience of ten years

Laparoscopic colorectal surgery for colorectal polyps: experience of ten years

Evaluation of an early‐stage innovation for full‐thickness excision of benign colonic polyps using the IDEAL framework

Combined endoscopic and laparoscopic surgery may be an alternative to bowel resection for the management of colon polyps not removable by standard colonoscopy

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