Management of invasive carcinoma in pedunculated colorectal polyps

Management of patients with endoscopically removed pedunculated colorectal polyps found to contain invasive carcinoma is controversial. When the endoscopist is confident that the polyp has been completely removed and the margins are pathologically clear, the salient issue which should guide subsequent management is the likelihood of lymph node metastases. Analysis of several institutional reviews has led the authors to conclude that the incidence of lymph node metastases is negligible in those patients in whom careful pathologic examination discloses free margins of resection, absence of lymphatic invasion, and well-differentiated or moderately well differentiated histology. Adhering to these criteria, pedunculated polyps containing invasive carcinoma can be safely managed by endoscopic polypectomy alone.