Management of the colorectal polyp referred for resection: A case-matched comparison of advanced endoscopic surgery and laparoscopic colectomy

Abstract

BackgroundColonoscopy is the gold standard for colorectal screening and surveillance. Advanced endoscopic polypectomy techniques such as endoscopic submucosal dissection (ESD) have been introduced to remove large colorectal polyps. Our aim was to compare the outcomes of patients who underwent ESD with those of who underwent laparoscopic colectomy for benign colorectal polyps. MethodsPatients with a preoperative diagnosis of benign colorectal polyp who underwent ESD or colectomy between 2011 and 2016 were case matched for age, sex, body mass index, American Society of Anesthesiologists status, polyp size, and location. Outcomes and cost data were analyzed. Polyps proximal to the splenic flexure were grouped as right-sided polyps, and polyps distal to the splenic flexure were grouped as left-sided polyps. ResultsWe identified 144 patients in the laparoscopic resection group and 111 patients in the ESD group; 48 patients met the matching criteria. Of the 48 patients in the ESD group, 5 required operative resection. Mean duration of stay in laparoscopic resection group and the ESD group was 5.2 ± 2.4 days vs 1.5 ± 1.4 (P < .001). Mean operative time was no different (136 ± 45 vs 133 ± 72.7 minutes, respectively). Six patients had follow-up colonoscopy within a year in the laparoscopic resection group versus 22 patients in the ESD group. The laparoscopic group had 21% complication rate versus 15% for the ESD group (P > .05). ESD had a 43% cost-reduction advantage over laparoscopic colectomy, with a 44% and 39% cost advantage for right- and left-sided lesions, respectively. ConclusionESD is more cost effective than conventional segmental resection. With an experienced endoscopist, ESD can be offered as a colon-preserving procedure.