Introduction Giant colonic polyps ( ≥ 3 cm) harbour a malignant risk in excess of 40%. Although endoscopic mucosal resection (EMR) is the treatment of choice, surgical resection is considered when endoscopic resection has failed or is unfeasible. We aimed to define the characteristics of patients who underwent surgical management of giant colonic polyps. We assessed the indications, malignant risk and postoperative complications in this cohort.
Method We performed a prospective case series of patients who had undergone surgical resection for giant colonic polyps. We collected data over 8 years (August 2008 - August 2016) in a district general hospital within the UK with tertiary EMR expertise. Patients were included if they had giant polyps confirmed endoscopically but were unresectable or had failed EMR. Data on demographics, polyp morphology, surgical modality, complication rates and histology were collected.
Results 38 patients were included, with a mean age of 74 years. Mean polyp size was 53 mm, with 22 (58%) being left sided. 36 (95%) were Kudo IV. Indications for surgery included: non-lifting (n=18; 47%), limited access (n=5; 13%), suspicious histology/radiology (n=13; 34%), EMR failure (n=1) and familial polyposis (n=1). Mean interval between index colonoscopy and surgery was 136 days. Surgical management consisted of: right hemicolectomy (n=16; 42%), left hemicolectomy (n=1; 3%), anterior resection (n=13; 21%), abdominoperineal resection (n=1), panproctocolectomy (n=1) and transanal excision (n=4, 11%). 14 (37%) were laparoscopic procedures. 7 patients (18.4%) required repeat surgery. In the 90 day postoperative follow-up period, no deaths were observed, but complications occurred in 9 patients (24%), comprising of unintended laparotomy (3), venous thrombosis (2), ileus (2), infection (1), and adhesional obstruction (1). Histology acquired during endoscopy comprised of: low grade dysplasia (n=23; 61%) high grade dysplasia (n=8; 21%), adenocarcinoma (n=3; 8%), suspicious cellular atypia (n=2; 5%). The prevalence of neoplasia in surgical specimens which were initially benign based on endoscopic biopsy was 13/33 (39%).
Conclusion Surgical management of giant polyps confers high postoperative morbidity. However, neoplasia was detected in 39% which would otherwise have been considered benign. In view of this, we suggest that giant polyps should be discussed in a multidisciplinary setting. This may facilitate timely management of polyps deemed unsuitable for endoscopic resection.
. Nusko Get al. Endoscopy1997;29:626–31.
Disclosure of Interest None Declared
- colonic polyps