Introduction Management of colorectal polyp cancers is variable, with no clear consensus on whether endoscopic mucosal resection (EMR) or local resection is optimal. We studied the outcome of 42 patients with colorectal polyp cancers in our hospital over a 3year period.
Method 42 cases of malignant colorectal polyps between May 2012 and May2014 were identified retrospectively from the histology database. Data was collected on polyp morphology and histology including resection margin, tumour grade, lymphovascular invasion and Haggitt/Kikuchi level of invasion. All specimens were examined by a single histopathologist. Adverse oncological outcome was defined as residual tumour at the polypectomy site and/or lymph node metastases in the surgical group and local/distant recurrence in the surveillance group. Post operative morbidity and method and timing of surveillance were documented.
Results 42 polyps (22 male and 20 female patients, mean age: 68 years, range: 33 to 90 years) were included. 59% of polyps appeared pedunculated at endoscopy with 27% sessile and 14% described as a “lesion.” 5 patients had radiological evidence of metastases. 43% of tumours were visible on imaging with 19% having mesorectal/presacral nodes.
13 patients underwent colonic resection. 8 of those had pedunculated polyps, 5 had sessile polyps. In 7 patients who underwent colectomy, polypectomy or EMR had been performed. Morbidity included 3 stomas (all reversed), 2 anastomotic leaks, 1 wound infection and 1 high output stoma. There were no deaths.
Endoscopic resection was the sole treatment in 29 patients; 7 patients with sessile polyps, 17 patients with pedunculated polyps and 5 with “lesions.”
Follow up was by imaging only in 15 patients, endoscopy only in 9 patients and a combination of imaging and endoscopy in 11 patients. 6 patients had no follow up.
Conclusion This study illustrates the varied management of malignant colorectal polyps. It is clear that resection margins adversely affect outcome. A strategy is needed for managing patients with clear resection margins, including nature and timing of follow up.
Disclosure of interest None Declared.
Williams J. G, et al. Managament of the Malignant colorectal polyp: ACPGBI position statement. Colorectal Dis. 2013;15:1–38
Naqvi S, et al. Management of colorectal polyp cancers. Ann R Coll Surg Engl. 2012;94:574–578
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