Trends, patterns, and outcomes in the management of malignant colonic polyps in the general population of the United States

Abstract

BACKGROUND: Colonoscopic screening has increased detection of malignant colonic polyps (MPs). The goal of this study was to analyze trends and patterns in the surgical treatment of MPs and to assess outcomes as measured by lymph node retrieval and patient survival. METHODS: The Surveillance, Epidemiology, and End Results (SEER) registry was queried to identify 19,743 patients with MPs from 1988 to 2003. RESULTS: The majority of MPs were present in the sigmoid and descending colon (54%), and 38% were tubular, 40% were tubulovillous, and 22% were villous. During the study period, the incidence of MPs increased from 29% to 42% and surgical resection (SR) was increasingly used for treatment, from 54% to 70%. Predictors of SR were aged <70 years (odds ratio [OR], 1.3; 95% confidence interval [95% CI], 1.2-1.4), high-grade tumors (OR, 1.5; 95% CI, 1.2-1.9), diagnosis in 1999 through 2003 (OR, 1.7; 95% CI, 1.5-1.9), villous subtype (OR, 2.3; 95% CI, 2.0-2.6), and right colon location (OR, 8.1; 95% CI, 7.0-9.4). In patients undergoing SR, the mean and median number of lymph nodes was only 4 and 1, respectively. A significant percentage of patients (49%) had no lymph nodes retrieved and a worse overall survival at 5 years compared with patients who had at least 1 lymph node examined (64% vs 74%; P <.001). CONCLUSIONS: MPs appear to be increasing in incidence, and there is a trend toward increased use of SR for treatment. However, patients undergoing SR for MPs undergo suboptimal assessment of lymph nodes, with a detrimental impact on survival. Adequate lymphadenectomy and lymph node evaluation are crucial to improve outcomes in patients with these potentially curable lesions.

The management of malignant polyps in colorectal cancer screening programmes: A retrospective Italian multi-centre study

“…With regard to the site of malignant polyps in our series, our result (56%) of left colon localisation is in keeping with data published by Wasif et al [9], whereas we had a slightly higher right colon localisation than that reported in the meta-analysis by Hassan et al [10].…”

“…They described -in a general population setting -a median removal of just one node. This type of behaviour has prognostic consequences, as patients with fewer resected lymphnodes have been shown to have a survival disadvantage [9].…”

Laparoscopic colorectal surgery for colorectal polyps: experience of ten years

“…Furthermore, Wasif et al showed that polyps larger than 3 cm could be completely excised only in 67-75% of cases, thus questioning the endoscopic approach (5). In our present study, a large polyp size is the commonest cause for laparoscopic removal of colorectal polyps after a suspected malignancy.…”

“…There are several methods to remove polyps by using either endoscopic, surgical, or combined methods (4). Patients who have known adenomas and refuse removal develop colon cancer at the rate of 4% after 5 years and 14% after 10 years, which is higher than that of the general population (5). Endoscopic removal of polyps has been shown to arrest subsequent development of carcinoma (6).…”

Practice parameters for early colon cancer management: Italian Society of Colorectal Surgery (Società Italiana di Chirurgia Colo-Rettale; SICCR) guidelines

“…An analysis from a large database in the USA demonstrated a median harvest of one node in patients who underwent colon resection for malignant polyps [127]. Gill, in the analysis of data of the Northern Colorectal Cancer Audit Group in UK on management of malignant colorectal polyp reported that the median lymph node yield was 9.0, reflecting current practice over a range of experience and hospital size from district general hospitals to tertiary referral centres [74].…”