Malignant Colonic Polyps Research Articles

ASO Visual Abstract: The Role of Tumor Location on Endoscopic and Surgical Management of Malignant Colon Polyps.

ASO Visual Abstract: The Role of Tumor Location on Endoscopic and Surgical Management of Malignant Colon Polyps.

The Role of Tumor Location on Endoscopic and Surgical Management of Malignant Colon Polyps.

Endoscopic polypectomy could be an appropriate, definitive treatment for pathologic T1 (pT1) colon polyps without high-risk features. Prior studies suggested worse prognosis for proximal versus distal advanced-stage colon cancers following curative treatment. However, there is limited evidence on the prognostic impact of tumor location for pT1s. This was a retrospective cohort study using the Surveillance, Epidemiology, and End Results database to identify adults with T1NxMx or T1N0-3M0/x colon adenocarcinoma from 2000 to 2019. A total of 3398 patients underwent endoscopic polypectomy (17% proximal) and 28,334 had a partial colectomy (49% proximal) for pT1 adenocarcinoma. Following endoscopic polypectomy, 5-year overall and cancer-specific survival rates were 64% and 91% for proximal versus 83% and 96% for distal polyps, compared with 82% and 95% for proximal versus 88% and 97% for distal tumors after colectomy. In multivariable models, there was a greater difference in overall survival between proximal and distal polyps for those who underwent endoscopic versus surgical resection [hazard ratio (HR) 1.73, 95% confidence interval (CI) 1.49-2.02 vs. HR 1.13, 95% CI 1.08-1.18]. Patients with proximal versus distal polyps who underwent polypectomy also exhibited increased cancer-specific mortality (HR 1.94, 95% CI 1.37-2.75). However, cancer-specific survival variations based on tumor location were no longer observed in patients undergoing partial colectomy (HR 1.09, 95% CI 0.98-1.21). Proximal tumor location was independently associated with worse overall and cancer-specific survival following endoscopic polypectomy. However, after colectomy, the cancer-specific disparity based on tumor laterality was mitigated. These findings suggest that proximal location may be considered a high-risk feature in endoscopic polypectomy.

Comparative Study on Handheld, Modular, and Laboratory Raman Instruments for the Analysis of Colon Tissues and Colorectal Polyps

Portable Raman spectrometers may offer advantages for clinical medical diagnostics over laboratory instruments by allowing for quick measurements in the field and provision of data suitable for screening analyses. This work evaluates the potential of using available handheld, modular, and laboratory Raman spectrometers for screening normal colon tissues and benign and malignant colon polyps. The Raman spectra of tissue samples and reference biological macromolecules were measured with these instruments and analyzed using curve fitting and multivariate statistics. The spectra of calf thymus DNA measured with portable devices showed suitable signal-to-noise levels and half-widths of the prominent bands. Band positions, resolution, and relative intensities in the Raman spectra of colon tissues and reference compounds varied for the instruments, and the laboratory device demonstrated the best spectral feature. The principal component analysis (PCA) of the spectra obtained with all Raman devices showed well discrimination of normal colon tissue, adenomatous polyp, and adenocarcinoma. Dendrograms of similarity obtained using hierarchy cluster analysis (HCA) for the Raman spectra of all three devices also showed good separation of these samples. The soft independent modeling of class analogy (SIMCA) and support vector machine (SVM) models efficiently classified normal colon tissues and benign/malignant colorectal polyps based on the Raman data from all three devices. Despite its less pronounced spectral characteristics, the handheld Raman spectrometer can be used in early diagnosis of colorectal carcinoma, comparable to the modular and laboratory instruments.

S1238 Using an Endoscopic Full Thickness Resection Device to Obtain Histologically Complete Resection or Formal Staging in Patients With Previous Piecemeal Resection of Malignant Colon Polyps

S1238 Using an Endoscopic Full Thickness Resection Device to Obtain Histologically Complete Resection or Formal Staging in Patients With Previous Piecemeal Resection of Malignant Colon Polyps

Prognostic Roles and Survival Benefits of Endoscopic Resection Versus Surgical Resection in the Management of Malignant Colon Polyps

Abstract Background Due to few sufficient data regarding the comparison between endoscopic and surgical resection of malignant colorectal polyps regarding outcomes and survival benefits, there are no clear guidelines of management strategies of malignant colorectal polyps.The aims of the present study were to compare endoscopic resection alone and surgical resection in patients with malignant polyps in the colon (T1N0M0) readings advantages, disadvantages, recurrence risks, survival benefits, and long-term prognosis to detect how management strategy affects outcome. Patients and methods we included 350 patients. All included patients were divided into 2 groups; the first group included 100 patients who underwent only endoscopic polypectomy and the second group included 250 patients who underwent endoscopic polypectomy followed by definitive surgical resection after histopathological diagnosis.We followed all patients for about 5 years, ranging from 18 to 55 months.The primarily evaluated parameters are surgical consequences and patients' morbidity. The secondary evaluated parameters are recurrence risks, recurrence free survival, and overall survival rates. Results The age of patients who underwent polypectomy is usually younger than the surgical group, males have more liability to polypectomy in comparison with females.Patients with tumors in the left colon have more liability to polypectomy in comparison with the right colon (p < 0.0001). Tumor factors associated with more liability to surgical resection are presence of lymphovascular invasion, high grade, and poor tumor differentiation (p < 0.0001).The management strategy was the most significant predictor of overall and recurrence free survival rates in patients with malignant colon polyps (p < 0.001). Conclusions We found that survival benefits and lower incidence of recurrence are detected in the surgical resection group more than in the polypectomy group.

Evaluation of IR and Raman spectroscopic markers of human collagens: Insides for indicating colorectal carcinogenesis

Vibrational spectroscopic methods are widely used in the molecular diagnostics of carcinogenesis. Collagen, a component of connective tissue, plays a special role as a biochemical marker of pathological changes in tissues. The vibrational bands of collagens are very promising to distinguish between normal colon tissue, benign and malignant colon polyps. Differences in these bands indicate changes in the amount, structure, conformation and the ratio between the individual structural forms (subtypes) of this protein. The screening of specific collagen markers of colorectal carcinogenesis was carried out based on the FTIR and Raman (λex 785 nm) spectra of colon tissue samples and purified human collagens. It was found that individual types of human collagens showed significant differences in their vibrational spectra, and specific spectral markers were found for them. These collagen bands were assigned to specific vibrations in the polypeptide backbone, amino acid side chains and carbohydrate moieties. The corresponding spectral regions for colon tissues and colon polyps were investigated for the contribution of collagen vibrations. Mentioned spectral differences in collagen spectroscopic markers could be of interest for early ex vivo diagnosis of colorectal carcinoma if combine vibrational spectroscopy and colonoscopy.

Polyp Size and Shape Estimation by Using an Endoscopic Hood Information

Medical doctors identify benign or malignant colon polyps by their size and shape. Since this identification is related to whether or not resection surgery is necessary, a technology for estimating absolute size and shape from endoscopic images is required. In previous research, the method for recovering the size and shape of polyps using a blood vessel region as a reference object has been proposed. This paper proposes a method to recover the size and shape of polyps by using a cylindrical endoscopic hood as a reference object. The experimental results confirm that the proposed method can estimate reflectance factor without using blood vessel information.

Endoscopic polypectomy for malignant polyps: Should tumor location (right versus left side) guide clinical decisions?

BackgroundCurrent guidelines consider endoscopic resection appropriate treatment for malignant colon polyps with negative margins, low-grade histology, and no lymphovascular invasion. While increasing literature demonstrates a worse prognosis for advanced stage right- versus left-sided colon cancers after curative treatment, there is paucity of data regarding prognostic effect of location in patients undergoing endoscopic resection of T1 polyps. We hypothesized the more aggressive biologic behavior observed in advanced right-sided cancers would be similarly represented in malignant polyps, and this location would be associated with lower overall survival. MethodsThe National Cancer Database was queried for adults with T1NxMx tumors who underwent endoscopic polypectomy (2004–2017). Patients with positive margins or without follow-up information were excluded. ResultsA total of 2,337 patients met inclusion criteria; 22% had right-sided polyps. Endoscopically excised proximal tumors were more common in elderly, and those with public insurance and more comorbidities (all P < .01). Among patients with complete pathologic data, there were no statistical differences between right- and left-sided polyps with 1 cm median size, >92% without lymphovascular invasion, and 100% without tumor deposits. Univariate analysis showed 73% vs 86% 5-year overall survival for right versus left polyps (P < .01). After adjustment for available confounders, right-sided location remained significantly associated with worse overall survival (hazard ratio 1.49, 95% confidence interval 1.21–1.83). ConclusionIn this national cohort of patients with endoscopically excised malignant polyps, we identified right colon location as an independent prognostic factor associated with increased risk of mortality. Our data suggest polyp location should be taken into consideration when making clinical decisions regarding treatment and/or surveillance.

Huge Colonic Granuloma of Schistosomiasis Mimicked Cancer in a 10-Years-Old Child: A Case Report

IntroductionSchistosomiasis is a trematodes infection more prevalent in tropical and subtropical areas such as Yemen. Giant colonic polyp manifestations of intestinal bilharziasis are uncommon, difficult to differentiate from other colonic polyps, and can mimic cancer.Case ReportA 10-year-old child presented with chronic abdominal pain that started ten months ago. The patient had a family history of lymphoma in his brother. The computed tomography scan showed a sigmoid luminal mass measuring 10×3 cm with significant lumen narrowing and diffuse circumferential wall thickening of the sigmoid colon, hepatomegaly, and multiple perilesional, para-hepatic, and pulmonary lymph nodes enlargements. The mass was morphologically mimicked cancer and proved to be of bilharzial etiology (Schistosoma mansoni) after surgical excision.ConclusionEven though the bilharzial colonic polyps are rare, it is challenging to differentiate them from other malignant colonic polyps. Clinicians should have a high suspicion regarding its manifestations to avoid unnecessary surgical interventions, especially in an endemic area, even in patients with a strong family history of cancer.

Malignant colon polyps: predicting lymph node metastasis following endoscopic excision.

The risk of lymph node metastasis (LNM) of malignant colon polyps (MCPs) is partly estimated by histologic features of the sampled polyp. However, the routinely available histologic data is limited to tumor grade and status of lymphovascular invasion (LVI). The NCDB for colon cancer 2004-2018 was utilized. Patients with pT1Nx adenocarcinoma arising in a polyp and undergoing partial colectomy with ≥ 12 retrieved nodes were selected. NCDB 2004-2017 was used as a training cohort to develop two scoring systems based on a multivariable regression for predictors of LNM including clinical characteristics, grade, and LVI: a nomogram scoring system (NSS) and a simplified scoring system (SSS). These models were internally validated using NCDB 2018 to calculate precision metrics for each model. Six thousand sixty-nine patients were selected in the training cohort. 64.5% of MCPs were in the sigmoid, and LNM rate was 11.2%. Multivariable regression identified younger age, females, hindgut location, higher grade, and LVI as significant predictors of LNM. LNM risk was 1.2% when all unfavorable predictors were absent and exceeded 10% when NSS > 70 or SSS ≥ 3. In the 2018 validation cohort, 723 patients were scored per NSS and SSS, and the negative predictive value for both was 96%. Estimating LNM risk in MCPs by applying clinical characteristics along with limited histologic data can help inform decision-making when considering formal oncologic resection. The NSS and SSS demonstrated comparable predictability of LNM among pT1Nx MCPs. The models require external validation and may be strengthened by incorporating additional endoscopic and pathologic characteristics.

Ex Vivo Vibration Spectroscopic Analysis of Colorectal Polyps for the Early Diagnosis of Colorectal Carcinoma.

Colorectal cancer is one of the most common and often fatal cancers in humans, but it has the highest chance of a cure if detected at an early precancerous stage. Carcinogenesis in the colon begins as an uncontrolled growth forming polyps. Some of these polyps can finally be converted to colon cancer. Early diagnosis of adenomatous polyps is the main approach for screening and preventing colorectal cancer, and vibration spectroscopy can be used for this purpose. This work is focused on evaluating FTIR and Raman spectroscopy as a tool in the ex vivo analysis of colorectal polyps, which could be important for the early diagnosis of colorectal carcinoma. Multivariate analyses (PCA and LDA) were used to assist the spectroscopic discrimination of normal colon tissue, as well as benign and malignant colon polyps. The spectra demonstrated evident differences in the characteristic bands of the main tissue constituents, i.e., proteins, nucleic acids, lipids, polysaccharides, etc. Suitable models for discriminating the three mentioned diagnostic groups were proposed based on multivariate analyses of the spectroscopic data. LDA classification was especially successful in the case of a combined set of 55 variables from the FTIR, FT Raman and dispersion Raman spectra. This model can be proposed for ex vivo colorectal cancer diagnostics in combination with the colonoscopic extraction of colon polyps for further testing. This pilot study is a precursor for the further evaluation of the diagnostic potential for the simultaneous in vivo application of colonoscopic Raman probes.

Predictors of lymph node metastases in patients with malignant adenomatous polyps of the colon

BackgroundWe sought to describe predictors of lymph node positivity in patients with malignant colon polyps to identify low risk patients who may potentially avoid radical surgery. DesignThe National Cancer Database (2010–2015) was queried for all patients with malignant colonic polyps who underwent formal colonic resection. Univariate and multivariate methods were used to determine independent predictors of lymph node metastasis. Results14,663 patients were identified. Lymph node disease was present in 9% of patients. High-grade disease, LVI, PNI, younger age, and left sided location were univariate predictors of lymph node disease. High-grade disease (OR 1.84), left sided location (OR 1.31), LVI (OR 5.79), and PNI (OR 1.70) were independent predictors, while elderly age (OR 0.64) was protective (all p-values <0.001). Elderly patients with low grade disease of the right/transverse colon without LVI/PNI had a 4.4% risk of lymph node disease. High grade, left-sided tumors with LVI, non-elderly age, had a 30% risk. ConclusionNon-elderly age, left-sided location, LVI, PNI and high-grade histology are independent predictors of lymph node metastasis in malignant colonic polyps.

Expert Commentary on Management of Malignant Colon Polyps.

Colorectal Surgery Section, Department of Surgery, University of Colorado, Aurora, Colorado Funding/Support: None reported. Financial Disclosure: None reported. Correspondence: Jon D. Vogel, M.D., University of Colorado, 12631 E 17th Ave, Aurora, CO 80045. Email: [email protected]

S0250 Adenoma Detection Rate of AmplifEYE™-Assisted Colonoscopy in Surveillance Colonoscopy

INTRODUCTION: Colonoscopy is the gold standard in detection of malignant and premalignant colon polyps. It is estimated that missed adenomas account for 50% of interval colorectal cancers. Different adjunctive modalities and devices have been trialed, including external caps on the tip of the endoscope to improve fields of view. There is conflicting evidence of cap-assisted colonoscopy and benefit of adenoma detection among the average risk population. Given the lack of consensus regarding the overall benefit of cap-assisted colonoscopy, our study aimed to compare the adenoma detection rate with AmplifEYE™-assisted colonoscopy versus standard colonoscopy in high-risk patients that require surveillance colonoscopy. METHODS: This was a single center, prospective, randomized controlled study testing adenoma detection of the AmplifEYE™ Endoscopy Device among high-risk patients undergoing surveillance colonoscopy. Informed written consent was obtained prior to randomization and colonoscopy. Patients were randomized to either the AmplifEYE™ or the standard colonoscopy control group. Demographic data, colonoscopy procedure and pathology reports, and colonoscopy preparation data were collected and analyzed. Data collection started in October of 2019 and is currently ongoing. Univariate analysis was performed. RESULTS: At time of analysis, 18 patients were randomized to the control group and 17 patients were randomized to the AmplifEYE™ group. The control group and AmplifEYE™ group had a median age of 68 and 59 years of age, respectively (P = 0.0216). No sex or race differences were detected. No colonoscopy timing differences were found relating to insertion time to cecum (6 vs. 7 min; P = 0.2290), withdrawal time (8 vs. 10 min; P = 0.2551), or total procedure time (15 vs. 17 min; P = 0.2974) among either group. No differences were found in polyp detection (56% vs. 47%; P = 0.6152). No diminutive polyps were detected in the AmplifEYE™ group. No correlation was observed between polyp location or pathology among the two groups (Table 1). CONCLUSION: The AmplifEYE™-assisted colonoscopy did not show superiority to a standard colonoscopy in regards to polyp detection. The AmplifEYE™ device group did not detect any diminutive polyps which raises concerns about polyp detection effectiveness, however, population size is a limiting factor. More data needs to be collected to detect procedure length differences or if polyp detection rates are correlated. Data collection is currently ongoing and will conclude in October of 2020.Table 1

Management of malignant colonic polyps.

With the implementation of colorectal cancer screening programs, there has been an increasing incidence of malignant colonic polyps (MP). The attending surgeon is often faced with the management dilemma of whether polypectomy can be considered adequate treatment or if formal oncological resection is required. While endoscopic therapy avoids the risks and morbidity of surgery, there is a potential trade-off of under-staging and inadequate treatment. Surgery, on the other hand confers the benefits of clear resection margins, nodal staging and the ability to prognosticate and guide the decision for adjuvant therapy. This article sets out to review the histopathologic prognostic factors of MP and the various management and surveillance strategies.

Role of Endoscopic Resection Versus Surgical Resection in Management of Malignant Colon Polyps: a National Cancer Database Analysis

BackgroundEndoscopic resection (polypectomy) or surgery, are the main approaches in management of malignant colon polyps. There are very few large population-based studies comparing outcomes between the two. MethodsUsing the National Cancer Database, we identified patients ≥ 18 years with the first diagnosis of T1N0M0 malignant polyp from 2004 to 2015. Patients with a positive resection margin were excluded. Outcomes were compared between those who had surgery versus those who had polypectomy. Overall survival was compared using Kaplan-Meier curves. Multivariate Cox proportional hazards analysis was performed to generate hazard ratios, adjusted for patient, demographic, and tumor factors. ResultsA total of 31,062 patients met the inclusion criteria, out of which 2593 (8.3%) underwent polypectomy alone and 28,469 (91.7%) had surgery. Overall survival was significantly better in the surgical group compared with the polypectomy group. One-year and 5-year survival for surgery were 95.8% and 86.1% respectively compared with 94.2% and 80.6% for polypectomy (p < .0001). Hazard ratio for surgery after adjusting for various clinical-, demographic-, and tumor-level factors was 0.53 (p < .0001). ConclusionOur study is the largest population-based analysis of patients with T1N0M0 malignant colon polyps. Overall survival was higher in patients who underwent surgery compared with polypectomy. This remained consistent even after adjusting for multiple patient and tumor factors between the two groups.

1039 – Role of Endoscopic Resection Versus Surgical Resection in Management of Malignant Colon Polyps: A National Cancer Database Analysis

1039 – Role of Endoscopic Resection Versus Surgical Resection in Management of Malignant Colon Polyps: A National Cancer Database Analysis

Management of malignant colon and rectal polyps (T1) after endoscopic polypectomy: analysis of pathological risk factors for lymph nodes metastasis. A retrospective multicentric observational study. POST-1 (Polypectomy Or Surgery for T1)

Management of malignant colon and rectal polyps (T1) after endoscopic polypectomy: analysis of pathological risk factors for lymph nodes metastasis. A retrospective multicentric observational study. POST-1 (Polypectomy Or Surgery for T1)

Complete endoscopic mucosal resection of malignant colonic sessile polyps and clinical outcome of 51 cases

Complete endoscopic mucosal resection of malignant colonic sessile polyps and clinical outcome of 51 cases

Complete endoscopic mucosal resection of malignant colonic sessile polyps and clinical outcome of 51 cases.

BackgroundMeta-analyses and guidelines recommend that deep submucosal invasion (>1 mm) of malignant sessile colonic polyps is an important risk factor for lymph node metastasis. However, existing data are based on small retrospective studies with marked heterogeneity. We herein aimed to investigate the long-term outcomes of patients who underwent complete endoscopic mucosal resection (EMR) of malignant colonic sessile polyps invading the submucosal layer.MethodsEndoscopy records for the period 2000-2016 were reviewed retrospectively. All enrolled patients exhibited an endoscopically resected malignant colonic sessile polyp. All patients were advised to undergo surgery, but some opted for conservative treatment and endoscopic follow up.ResultsFifty-one patients with confirmed infiltrative submucosal adenocarcinoma in sessile colonic polyps that had undergone complete EMR were detected. A total of 32 (62.7%) patients opted for surgery after EMR and 19 (37.3%) chose endoscopic follow up. In 44 (86.3%) patients the submucosal invasion was >1 mm. Residual malignant disease was identified in the surgical pathological specimen of only 1 patient. During a median follow up of 23.41 months (interquartile range 33.45, range 1.84-144.92), no local recurrences or lymph node metastasis were identified. Forty-nine patients are alive without evidence of disease and 2 died of other causes (without evidence of local or metastatic disease at last follow up).ConclusionOur data suggest that complete EMR of cancerous colonic sessile polyps, even in cases of submucosal invasion >1 mm carries a low risk of recurrence and therefore may need further evaluation as an alternative strategy to surgical resection.