The fate of patients following polypectomy alone for polyps containing invasive carcinoma

Abstract

Eighty-two patients with colon and rectal polyps containing invasive adenocarcinoma treated by polypectomy alone were studied. Seven of 34 patients (21 percent) with sessile lesions had an adverse outcome, including five local recurrences and two distant metastases. They occurred from 4 to 68 months after the polypectomy. Forty-seven pedunculated polyps with invasion to the head (Level 1) or to the stalk (Level 3) and one polyp to the base of the stalk (Level 4) had no evidence of local recurrence or signs of metastasis. Twenty-eight percent of patients were found to have adenomatous polyps, and 4 percent had malignant polyps during the follow-up examinations (range, 3-119 months; mean, 53 months). The findings suggested that pedunculated polyps with invasion to the head (Level 1), neck (Level 2), or stalk (Level 3) can be safely treated with a complete polypectomy provided that the carcinoma is not undifferentiated. Sessile lesions as well as Level 4 pedunculated lesions should be treated aggressively. If resection is not performed, a long-term follow-up in these patients is essential.

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.…”

“…Regarding endoscopic data, polyp site was clearly specified in 17 series, accounting for 1,461 polyps. 14,[20][21][22]24,26,27,29,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]39 In such studies, the rectum was involved in 19.6 percent of the cases, the left colon in 71 percent, and the right colon in the remaining 9.4 percent. Polyp morphology was available in 19 series, enrolling 1,145 polyps.…”

“…[12][13][14][16][17][18][19][20][21][22][23][25][26][27][28][29][30][31][32][33]35,[37][38][39][40][41][42] Poor differentiation was described in 116 (7.2 percent) of 1,612 polyps. Subgrouping for morphology, poor differentiation was more frequently detected in sessile (25/214) than in pedunculated (21/308) polyps (11.7 vs. 6.8 percent; P = 0.05).…”

“…Subgrouping for morphology, poor differentiation was more frequently detected in sessile (25/214) than in pedunculated (21/308) polyps (11.7 vs. 6.8 percent; P = 0.05). 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).…”

“…[12][13][14]16,[18][19][20][21][22][23]25,26,[28][29][30][31]33,35,39,[40][41][42] This risk factor tended to be more frequent in sessile (30/214) compared with pedunculated (30/327) polyps (14 vs. 9.2 percent, respectively; P = 0.08). 12,20,21,26,28,33,35 Lymph node metastasis was much more common in polyps with such a risk factor than in those without it, whereas no substantial difference in residual disease, hematogenous metastasis, or cancer-related mortality was detected (Table 1).…”