Related Experiment Video
Updated: May 20, 2026
Competing-Risk Nomogram for Predicting Cancer-Specific Survival in Multiple Primary Colorectal Cancer Patients after Surgery
Published on: September 27, 2024
Factors affecting the treatment of multiple colorectal adenomas
Emanuele D L Urso1, Riccardo Nascimbeni, Salvatore Pucciarelli
1Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Azienda Ospedaliera University of Padova, Padova, Italy. edl.urso@unipd.it
Background:
Currently, no guidelines exist for the treatment of patients with multiple colorectal adenomas (MCRAs) (>10 but <100 synchronous nondiminutive polyps of the large bowel). This retrospective study aimed to investigate the clinical and molecular factors related to different treatments for MCRAs.
Methods:
Patients with MCRAs were consecutively enrolled from January 2003 to June 2011. Sequencing of their APC and MutYH genes was performed. The clinical, molecular, and family histories of the patients were collected using the Progeny database. The patient treatments were divided into three groups of increasing clinical weight: endoscopic polypectomy, segmental resection, and total colectomy. A logistic regression analysis of clinicomolecular factors related to different treatment options was performed.
Results:
The study comprised 80 patients (32 women, 40%) with a median age of 53 years (range 13-74 years). The median number of polyps was 33 (range 10-90).The cases included 62 diffuse polyposis, 18 segmental polyposis coli and synchronous colorectal carcinomas (CRC; 34 cases, 43%). The pathogenetic mutations were biallelic MutYH (n = 19, 24%) and APC (n = 4, 5%). The mean follow-up period was 74 months (median 43 months, range 1-468 months). Endoscopic polypectomy was performed in 25 cases (31%), segmental resection in 16 cases (20%), and total colectomy in 39 cases (49%). The logistics regression analysis, considering all the patients, showed that the number of polyps, the presence of CRC, and mutation were correlated with more intensive treatment. For the patients without CRC, only the number of polyps was correlated with the severity of the treatment (p > 0.0166). "On the ROC (receiver operating characteristic) curve, 25 was the number of polyps that best discriminated between surgical and endoscopic therapy.
Conclusions:
The majority of patients with MCRAs undergo surgery. For patients without CRC, only the number of polyps, and not the presence of a disease-causing mutation, is correlated with increased heaviness of treatment. Patients with more than 25 polyps are more likely to undergo a surgical resection.
Insights
The number of colorectal polyps, not genetic mutations, influences treatment intensity for patients with multiple colorectal adenomas (MCRA). Over 25 polyps often indicates a need for surgical intervention rather than endoscopic removal.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Oncology
Background:
- Multiple colorectal adenomas (MCRA) lack established treatment guidelines.
- This study investigates factors influencing treatment decisions for MCRA.
Purpose of the Study:
- To identify clinical and molecular factors associated with different treatment modalities for MCRA.
- To provide evidence-based insights for managing patients with numerous colorectal polyps.
Main Methods:
- Retrospective analysis of 80 MCRA patients (2003-2011).
- Collected clinical, molecular (APC, MutYH genes), and family history data.
- Classified treatments into endoscopic polypectomy, segmental resection, and total colectomy.
- Utilized logistic regression and ROC curve analysis.
Main Results:
- 80 patients (median 33 polyps) included; 43% had colorectal cancer (CRC).
- Mutations found in 24% (MutYH) and 5% (APC).
- Number of polyps and CRC presence correlated with more intensive treatment.
- For non-CRC patients, polyp count was the primary factor for treatment severity.
- 25 polyps best distinguished between endoscopic and surgical treatment.
Conclusions:
- Most MCRA patients require surgical intervention.
- Polyp number, not mutations, dictates treatment intensity in non-CRC patients.
- More than 25 polyps predict a higher likelihood of surgical resection.
More Related Videos
08:26Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction
Published on: March 24, 2023
04:09The Pocket-Creation Procedure of Endoscopic Submucosal Dissection for Large Rectal Laterally Spreading Tumors
Published on: February 13, 2026
Related Concept Videos
01:11Pharmacogenetics of Drug Targets: β₂-Adrenergic Receptors, Apo E, Thymidylate Synthase
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD:
01:29Drugs for Treatment of Ulcerative Colitis in IBD