Management Of Malignant Colon Polyps Research Articles

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.

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.

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]

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

Surgical or endoscopic management of malignant colon polyps.

To evaluate indications for colectomy in T1 polyps and possible risk factors for lymph node metastasis. Between 2004 and 2017, 40 patients underwent colectomy after endoscopic removal of malignant polyps with T1 carcinoma. Resection was done based on at least one of the unfavourable histopathological criteria. We collected and prospectively studied histopathologic features, short-term results and the benefit-risk balance. Complications were assessed by Clavien-Dindo classification. Twenty-five patients (62.5%) underwent laparoscopic bowel resection. Twenty-nine patients (63.0%) had more than two unfavourable criteria in the polyp that justified colorectal resection. Thirty-five patients (76%) had G2 (moderately differentiated) cancer, 11 (24%) had G1 (well-differentiated). Five patients (12.5%) had lymph node metastases and one (2.5%) had residual adenocarcinoma. All five patients with lymph node metastasis had G2 cancer. Nine patients (22.5%) had residual adenoma. Overall complications were identified in six (15.0%) patients. Oncologic benefit (or risk factors for lymph node metastasis) was significantly associated with polyp size ≥18 mm (P = 0.006), lymphovascular invasion (P = 0.05) and budding (P = 0.02). Female gender, lymphovascular invasion, desmoplastic reaction, criteria for surgery ≥2 and polyp size ≥18 mm were all in complex significant risk factors for lymph node metastasis in T1 colorectal cancer. Acting as a single factor, these variables had no effect to increased risk of metastasis.

Management of malignant colonic polyps (T1). Endoscopic polypectomy vs surgery and analysis of pathological risk factors for lymph node metastasis: A prospective monocentric study

Colorectal cancer screening showed an increased incidence of malignant colonic polyps T1 after endoscopic excision. Their management is not yet standardized, for the presence of histological features increasing early lymph node involvement. The literature proposed several histopathological criteria only for endoscopic polypectomy. The purpose of this study was to prospectively determinate whether the criteria set out in our Center for only endoscopic resection have been validated by follow up.

Management of malignant colon polyps: current status and controversies.

Colon cancer remains a significant clinical problem worldwide and in the United States it is the third most common cancer diagnosed in men and women. It is generally accepted that most malignant neoplasms of the colon arise from precursor adenomatous polyps. This stepwise progression of normal epithelium to carcinoma, often with intervening dysplasia, occurs as a result of multiple sequential, genetic mutations-some are inherited while others are acquired. Malignant polyps are defined by the presence of cancer cells invading through the muscularis mucosa into the underlying submucosa (T1). They can appear benign endoscopically but the presence of malignant invasion histologically poses a difficult and often controversial clinical scenario. Emphasis should be initially focused on the endoscopic assessment of these lesions. Suitable polyps should be resected en-bloc, if possible, to facilitate thorough evaluation by pathology. In these cases, proper attention must be given to the risks of residual cancer in the bowel wall or in the surrounding lymph nodes. If resection is not feasible endoscopically, then these patients should be referred for surgical resection. This review will discuss the important prognostic features of malignant polyps that will most profoundly affect this risk profile. Additionally, we will discuss effective strategies for their overall management.

Management of Malignant Colonic Polyps: A Population-Based Analysis of colonoscopic Polypectomy Versus surgery

Management of Malignant Colonic Polyps: A Population-Based Analysis of colonoscopic Polypectomy Versus surgery

Management of malignant colonic polyps: A population‐based analysis of colonoscopic polypectomy versus surgery

The management of colon polyps containing invasive carcinoma includes surgical resection or colonoscopic polypectomy. To date, there are very limited population-based data comparing outcomes with the 2 management approaches. Using the linked Surveillance Epidemiology and End Results-Medicare database, we identified 2077 patients aged ≥66 years with an initial diagnosis of stage T1N0M0 malignant polyp from 1992-2005. Patients were categorized as surgical or polypectomy depending on the most invasive treatment. To adjust for potential selection bias in treatment assignment, using multivariate analysis, patients were divided into quintiles of likelihood of polypectomy (propensity scores), and outcomes were compared in each quintile. Surgical resection was performed in 1340 (64.5%) patients and polypectomy was performed in 737 (35.5%) patients. Predictors for undergoing polypectomy (P<.001) included older age, greater comorbidity, no history of polyps, diagnosis in 2002 or later, left colon site of cancer, well-differentiated tumors, and colonoscopy performed in an outpatient setting. Both 1-year and 5-year survival were higher in the surgical group (92% and 75%, respectively) than in the polypectomy group (88% and 62%, respectively). The unadjusted hazard ratio was 1.51 (95% confidence interval [CI], 1.31-1.74). After adjusting for propensity quintile, the hazard ratio was 1.15 (95% CI, 0.98-1.33). Within each propensity quintile, the risk of death was similar between the 2 groups (interaction test P = .96). In this large, population-based sample, more than one-third of patients with malignant polyps were treated with colonoscopic polypectomy. Outcomes were similar to surgical patients with comparable clinical characteristics and could be offered to patients who meet appropriate clinical criteria.

Endoscopic Versus Surgical Management of Malignant Colon Polyps: A Community-Based Comparative Analysis

Endoscopic Versus Surgical Management of Malignant Colon Polyps: A Community-Based Comparative Analysis

Surgical management of malignant colonic polyps often suboptimal

Surgical management of malignant colonic polyps often suboptimal

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

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. The Surveillance, Epidemiology, and End Results (SEER) registry was queried to identify 19,743 patients with MPs from 1988 to 2003. 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). 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. Cancer 2011. © 2010 American Cancer Society.

The Rationale for Current Practice in the Management of Malignant Colonic Polyps

The Rationale for Current Practice in the Management of Malignant Colonic Polyps

Polypes coliques malins : critères histologiques en vue de ľévaluation du traitement endoscopique

Endoscopic resection of neoplastic colonie polyps is a generally accepted treatment. It is also accepted that colonoscopy is the best follow-up method for patients with colonic adenomas.Adenomas with malignant epithelial areas were and are also treated by endoscopy. The therapeutical attitude in patients with malignant polyps in less clear and has been based on empirical criteria. During the last years various reports have been published discussing the management of malignant colonic polyps. They allow us to improve the planning of the further therapeutical attitude. We studied 58 patients treated for 65 malignant polyps and compared our findings with the data of the literature. The resection specimen with draining lymph nodes, coming from 17 patients who underwent an adjuvant colectomy were reexamined and fourty eight patients have been followed for a mean period of 6 years by clinical observation, endoscopy and sonography.The histological criteria studied are : 1. level of invasion of the carcinomatous component ; 2. the extent of carcinomatous involvement ; 3. the presence of vascular invasion ; 4. the degree of tumor differentiation ; 5. assessment of section margins ; 6. polyp type, size and shape. From the results of our study and from the data of the literature we can conclude that an accurate judgment of the resection margin, the degree of differentiation of the carcinomatous component and vascular invasion are important criteria for the determination of further therapeutical attitude. Accurate orientation of the poiyp is of essential importance for adequate assessment of the resection. Fragmentation of the lesion during the resection must be avoided.Malignant polyps can successfuly be treated by polypectomy on the condition that the resection margin is negative and that the carcinoma is not undifferentiated. The importance of vascular invasion cannot yet adequately be evaluated.

Management of patients with polyps containing malignancy removed by colonoscopic polypectomy.

The management of malignant colonic polyps removed colonoscopically has been a controversial subject. A continuing series is reported of 36 patients with 37 malignant polyps removed by colonoscopic polypectomy (CP) between 1976 and 1982. Fourteen polyps contained carcinoma in situ (CIS); 13 were treated by CP alone; one was treated by CP and colectomy. Nineteen polyps contained invasive carcinoma; 13 were treated by CP alone; six were treated by CP and colectomy. Four patients had sessile polyps resected piecemeal, in which accurate staging was impossible. Two were treated with CP alone, and two had CP plus colectomy. All patients were followed with yearly colonoscopy and/or barium enema. Follow-up has been six to 84 months (mean 36 months). Twenty-seven patients whose polyps were treated by CP alone have had no evidence of recurrent tumor at the polypectomy site. Of the nine patients undergoing colectomy, six had residual tumor at the polypectomy resection site. No patients had involved lymph nodes. Our current approach to this problem is based on the degree of invasion and the status of the resection margins. Polyps containing CIS can safely be treated with CP alone. Polyps with invasive carcinoma and clear resection margins should be treated with CP and either colectomy or frequent repeat colonoscopy. This decision is a clinical one and must involve input from both the clinician and the pathologist. Those polyps whose resection margins are involved or where piecemeal excision precludes accurate pathologic assessment should undergo colectomy.