Introduction The introduction of the bowel cancer screening programme (BCSP) has increased the detection of early colorectal cancers (CRC), including malignant polyps (MP). There remains, however, a lack of data on the ideal management of MPs. Formal operative bowel resection offers the sureity of extensive local resection (and assessment of loco-regional lymph nodes), but at the price of the attendant morbidity/mortality and, in cases of post-polypectomy resections, the specimen is often free of tumour. Endoscopic excision avoids that morbidity/mortality but at the potential price of local recurrence and undetected lymph node spread. The risk of residual disease after local or endoscopic resection based on histological factors is summarised in the ACPGBI position statement.1We aimed to assess outcomes of all patients treated for MPs in a single NHS trust.
Method All T1 M0 cancers with a date of diagnosis between 01/04/10–31/03/14 were identified from a prospective, consecutive database of CRCs treated in the Trust, and the demographic, treatment and pathology data items exported. Electronic records of all subsequent endoscopic, radiological and histological tests were then searched to identify subsequent outcomes. Primary outcomes were disease-specific mortality, disease recurrence and metastases.
Results Of 1238 CRCs ascertained, 130 (10.3%) fitted the inclusion criteria (T1 M0). Follow-up ranged from 3 to 58 months (median 34). Decision making in respect of local vs. formal surgical resection was based on multi-disciplinary discussion, informed by histopathological criteria where available, co-morbidities and patient preference. 34 (26.2%) underwent immediate formal resection, 68 (52.3%) were managed solely endoscopically, and 28 (21.5%) underwent endoscopic resection followed by completion colectomy (of which 24 had no residual disease). 10 patients died during follow-up, though none due to colorectal cancer or treatment. There was one case of liver metastases (who underwent local excision only, Kikuchi 2) and no local recurrences.
Conclusion The low incidence of recurrence and metastases in this cohort reinforces that appropriate local resection of MPs does not negatively affect outcome at intermediate follow-up. The current ACPGBI position statement scoring system appears to appropriately select patients at low risk of residual disease. It is of note that there was no residual disease in 86% of formal resection specimens. There were missing histopathological criteria in many patients due to fragmentation of specimens and lack of synoptic reporting. Improving the proportion of en bloc local resections plus synoptic reporting may reduce the need for ‘unnecessary’ resections.
Disclosure of interest None Declared.
Williams JG, et al. Management of the malignant colorectal polyp: ACPGBI position statement. Colorectal Dis.2013;15(Suppl 2):1–38
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