Abstract
Background/Aims The “Resect and Discard” strategy is a potentially useful strategy. At present, only the lesion size and accuracy of diagnosis are cited as considerations for clinical adoption of this strategy. On the other hand, histopathology of the resected specimens after Endoscopic Mucosal Resection (EMR) reveals often an unclear or positive-margin status, implying Incomplete Polyp Resection (IPR). If IPR indeed increased the risk of local recurrence, histopathological evaluation of the margin would be indispensable and clinical adoption of this strategy is difficult. The aim of this study is to verify the association between IPR and the risk of local recurrence. Methods The 1872 polyps and 603 EMR cases in 597 patients who had EMR between May 2013 and May 2014 were enrolled. The local recurrence rate until 3 years after the EMR in cases with the target lesions of the “Resect and Discard” strategy was determined in the negative-margin and IPR groups. Results The final analysis was performed using the data of 1092 polyps, and 222 were categorized into the IPR group. There were no cases of recurrence in either of the groups. Conclusion This is the world's first report conducted to examine the correlation of IPR and the local recurrence rate for clinical practice of “Resect and Discard” strategy. There is the possibility that pathological evaluation of the margins after EMR in patients with small polyps can be skipped.
Highlights
The incidence of colorectal cancer (CRC) continues to increase around the world [1, 2], and the importance of early detection and early treatment is growing
An important issue associated with early detection and early resection of colorectal polyps is escalation of the medical costs and increase in time and labor required for formal histopathological diagnosis of the large number of resected polyps resulting from the increased detection rates
The patient inclusion criteria were as follows: (a) at least one surveillance colonoscopy had been performed within 3 years after Endoscopic Mucosal Resection (EMR); (b) complete colonoscopy had been performed at every examination; (c) the final diagnosis was low-grade tubular adenoma; (d) the lesion was less than 10 mm in diameter
Summary
The incidence of colorectal cancer (CRC) continues to increase around the world [1, 2], and the importance of early detection and early treatment is growing. As EMR of colorectal polyps is an effective treatment for prevention of CRC, early detection and early resection of colorectal polyps is one of the fundamental strategies for reducing CRC mortality. The potential cost saving of not sending diminutive polyps for formal histopathology is Canadian Journal of Gastroenterology and Hepatology thought to exceed $95 million per year in the United States alone [12, 13]. The benefit of this strategy is not limited to cost reduction and includes savings in labor and pathology time [14]. The target lesions for this strategy should be selected carefully [15], this strategy has numerous potential benefits associated with the practice of early detection and resection of colorectal polyps for reducing CRC mortality
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