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Colectomy for endoscopically unresectable polyps: how often is it cancer?
Noelle L Bertelson1, Kristen A Kalkbrenner, Amit Merchea
1Department of Surgery, Mayo Clinic, Scottsdale, Arizona, USA. nbertelson@gmail.com
Diseases of the Colon and Rectum
|October 10, 2012
Summary
Malignancy is found in 17.7% of surgically resected benign polyps. Left colon polyps and high-grade dysplasia predict cancer, not polyp size or villous features.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Colorectal Surgery
Background:
- Colonoscopy is crucial for colorectal cancer (CRC) prevention by detecting and removing polyps.
- Colectomy is indicated for endoscopically unresectable polyps to prevent or treat malignancy.
Purpose of the Study:
- To determine the incidence of malignancy in surgically resected polyps initially deemed benign.
- To identify factors predicting malignancy in these resected polyps.
Main Methods:
- Retrospective chart review of 750 patients undergoing colectomy for colonic polyps without a preoperative cancer diagnosis.
- Analysis of patient demographics, polyp location/size, and pathology to correlate with invasive carcinoma.
- Multivariate analysis to assess predictive factors for malignancy.
Main Results:
- Invasive cancer was found in 17.7% of resected polyps.
- Left colon location (OR 2.13) and high-grade dysplasia (OR 4.60) significantly predicted malignancy.
- Polyp size, villous features, age, and sex did not predict malignancy.
Conclusions:
- Left colon polyps and high-grade dysplasia are key indicators for potential malignancy.
- Polyp size and villous features are less reliable predictors than previously thought.
- Radical oncologic resection is recommended for endoscopically unresectable polyps.
