Tu1440 Advanced Depressed Colorectal Cancer Shows a High Rate of Lymphatic Invasion, Venous Invasion and Nodal Metastasis Compared With Protruded-Type

Abstract

were asked questions regarding polyp characteristics, suspicion for malignancy, and recommendations for resection. Results: The survey response rate was 154/ 330 (46.7%). Seventy-eight percent of respondents were attending physicians (91 GI and 29 surgery) and 22% were GI trainees. Among the GI attendings, 24 (26.3%) self-identified as SCPs. Endoscopic removal was recommended by 86.3% of respondents for the 5 colorectal adenomas compared to 63.5% for the polyp with adenocarcinoma (P 0.001). SCP were least likely to recommend surgical removal of the four colon adenomas (3.1%) while surgeons were most likely (17.2%, P .008). Surgeons were also more likely to recommend surgical resection of the rectal polyp than GIs (44.8% vs. 14.3%, P 0.004). Among all respondents, surgical resection was recommended more often for nonpolypoid (Paris O-IIA) compared to polypoid (Paris Is or Ips) lesions (20% vs. 9.6%, P 0.003). No differences in recommendations for endoscopic versus surgical resection were observed based on years in practice, polyp location (right versus left colon), or patient ASA class. Non-SCP GIs recommended referral to an SCP for complex polypectomy in 33% of polyps. Referral by a non-SCP GI to an SCP was more likely to be recommended for non-polypoid lesions (47.3%) than polypoid lesions (33.0%, P 0.02); however, polyp location was not significantly associated with referral to an SCP. Conclusions: In this large survey of GIs and surgeons, physician specialty was a strong determinant for the decision of endoscopic versus surgical resection of complex polyps. Surgeons were most likely to recommend surgical resection of complex non-malignant colorectal polyps, whereas SCPs recommended surgery the least frequently. Among polyp characteristics, non-polypoid morphology was the sole predictor of a recommendation for surgical resection or referral to an SCP by a non-SCP GI for endoscopic resection.