Management and short‐term outcome of malignant colorectal polyps in the north of England1. (25th January 2013)

• Record Type: Journal Article
• Authors: Gill, M. D.; Rutter, M. D.; Holtham, S. J.
• Is Part Of: Colorectal disease. Volume 15:Number 2(2013)
• Page Start: 169
• Page End: 176
• Publication Date: 2013-01-25
• Subjects: Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; 616.34
• DOI: 10.1111/j.1463-1318.2012.03130.x
• Languages: English
• ISSNs: 1462-8910

Abstract

<abstract abstract-type="main" xml:lang="en"> <title>Abstract</title> <p> <bold>Aim </bold> Management of malignant colorectal polyps (MCP) is contentious, with no randomized controlled trials comparing endoscopic with surgical management. This study reviews the management and outcomes of MCPs across a UK region.</p> <p> <bold>Method </bold> Patients with a malignant polyp were identified using the NORCCAG (NORthern Colorectal Cancer Audit Group) database between April 2006 and July 2010. All histopathology reports and follow‐up procedures were reviewed.</p> <p> <bold>Results </bold> Of 386 patients identified, 165 (42.7%) had the polyp biopsied and 221 (57.3%) had an endoscopic local excision (37 piecemeal excision, 184 polypectomy). All patients having an endoscopic biopsy underwent surgery. 103 (46.6%) having a local excision had follow‐up surgery, of whom 79 (76.7%) had no residual cancer. Of the 118 patients managed endoscopically, none had residual cancer on follow‐up endoscopy. The 21 (5.4%) Dukes C cancers were associated with Kikuchi SM3/Haggitt 4 lesions (χ<sup>2</sup> = 10.85, <italic>P</italic> = 0.005) and lesions with an involved/unsure excision margin (χ<sup>2</sup> = 7.44, <italic>P</italic> = 0.017). Predictors of finding residual tumour at surgery after local excision were Kikuchi SM3/Haggitt Level 4 (χ<sup>2</sup> = 17.07, <italic>P</italic> < 0.001) and an involved/unsure excision margin (χ<sup>2</sup> = 20.45, <italic>P</italic> < 0.001). An excision margin > 0 mm was associated with the finding of no residual tumour (χ<sup>2</sup> = 25.21, <italic>P</italic> < 0.001). There was no difference in survival between surgical and endoscopic management (χ<sup>2</sup> = 0.634, <italic>P</italic> = 0.426) after a mean follow‐up of 25.1 months.</p> <p> <bold>Conclusion </bold> Endoscopic management of a subgroup of MCPs appears safe. A clear resection margin (> 0 mm) appears sufficient to avoid surgery, except in locally advanced lesions (Kikuchi 3/Haggitt 4) which have a greater risk of residual cancer at surgery and lymph node metastasis.</p> </abstract>