The malignant adenoma: when to operate and when to watch

Mitchell, Peter; Haboubi, Najib

doi:10.1007/s00464-008-9850-y

Cited by 13 publications

(14 citation statements)

References 34 publications

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“…There is no clear description of the CT/MR FU for this whole group. In contrast with most other publications in the literature [2,3] this study could not establish a link between lymphovascular invasion and the presence of residual tumour or lymph node metastasis. The authors, in the discussion section, warned against discounting the importance of these features but it is noteworthy that patients with ASA grades 3 and 4 were more likely to have surgery, despite being the very patients for whom endoscopic resection would be beneficial.…”

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Re. Gill et al.: Management and short‐term outcome of malignant colorectal polyps in the north of England

Gonsalves

Anwar

2013

Colorectal Disease

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References1 Zhang Y, Huang X. Gastrointestinal involvement in Henoch-Sch€ oenlein purpura. Scand J Gastroenterol 2008; 43: 1038-43. 2 Kempton CL, Bagby G, Collins JF. Ulcerative colitis presenting as purpura fulminans. Inflamm Bowel Dis 2001; 7: 319-22. 3 Watanabe T. Henoch-Sch€ onlein purpura following influenza vaccinations during the pandemic of influenza A (H1N1). Pediatr Nephrol 2011; 2: 795-8. 4 L opez-Serrano P, P erez-Calle JL, P erez-Fern andez MT et al. Environmental risk factors in inflammatory bowel diseases. Investigating the hygiene hypothesis: a Spanish case-control study. Scand J Gastroenterol 2010; 45: 1464-71. 5 Nobile S, Catassi C, Felici L. Herpes zoster infection followed by Henoch-Sch€ onlein purpura in a girl receiving infliximab for ulcerative colitis.

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Re. Gill et al.: Management and short‐term outcome of malignant colorectal polyps in the north of England

Gonsalves

Anwar

2013

Colorectal Disease

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“…The result of a study, which was recently conducted by Seit et al [21] on 114 patients who had undergone an endoscopic polypectomy of a malignant polyp, showed that poor outcomes were obtained from 60 high-risk patients due to the relevant malignant tumor whereas good outcomes were obtained from 54 low-risk patients regardless of the tumor. They suggested that a more active treatment should be conducted if risk factors are identified during the pathohistologic examination [21, 25]. In this study, surgery was performed on the patients that were considered to have risk factors on the histologic examination after the polypectomy.…”

Section: Discussionmentioning

confidence: 99%

Value and Interpretation of Resection Margin after a Colonoscopic Polypectomy for Malignant Polyps

Jang

Kim

Cho

2011

J Korean Soc Coloproctol

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PurposeThis study was designed to compare the clinicopathologic findings of an endoscopic polypectomy for malignant polyps with subsequent surgery and to evaluate the appropriateness of the pathologic finding criterion of the resection margin as an indicator for surgery in cases of malignant colorectal polyps.MethodsWe examined the clinicopathologic characteristics, complications and prognoses among the patients who underwent a colonoscopic polypectomy in both our hospitals and at other hospitals from April 2003 and April 2010. These patients were divided into two groups, the group (non-operation group) that only underwent a polypectomy (n = 37) and the group (operation group) that underwent a polypectomy with subsequent surgery (n = 33).ResultsThere were no differences between two groups in the ratios of the number of men to the number of women, the ages or the comorbidities. In terms of endoscopic findings, we found no differences between the two groups in the locations of the polyps, the sizes of the polyps, or the presence of stalks. However, ulceration of polyps was higher in the non-operation group (51.5% vs. 21.6%; P = 0.009), as was the case with submucosal invasion (75.8% vs. 16.2%; P < 0.005). When an endoscopic polypectomy was performed, incomplete resection margins and specimens with margins involved occurred more frequently in the operation group (93.9% vs. 51.4%; P < 0.005), but no residual tumor was detected in 31 of 33 (93.9%) patients in that group. One pathologist reviewed the specimens of 54 patients (operation group, 19; non-operation group, 36). Six of the 19 polyps (31.6%) in the operation group and fifteen of the 36 polyps (41.7%) in the non-operation group had a margin without cancer cells.ConclusionWe may accept the criterion of a safe margin, including a coagulation zone. A multidisciplinary approach has to be developed by surgeons, endoscopists and pathologists based on a discussion of the risk factors for the patient before making a decision on the treatment treatment.

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“…The preferred care for patients with polypectomy specimens which contain invasive carcinoma is controversial (Haboubi and Scott, 2000). Taking into considerations all factors involved, the issue of polypectomy for malignant polyps versus surgical resection is best resolved by a multidisciplinary team involving the surgeon, pathologist and endoscopist, taking the patient's condition and wishes into account (Mitchell and Haboubi, 2008).…”

Section: Resultsmentioning

confidence: 99%