Management of malignant colonic polyps

With the implementation of colorectal cancer screening programs, there has been an increasing incidence of malignant colonic polyps (MP). The attending surgeon is often faced with the management dilemma of whether polypectomy can be considered adequate treatment or if formal oncological resection is required. While endoscopic therapy avoids the risks and morbidity of surgery, there is a potential trade-off of under-staging and inadequate treatment. Surgery, on the other hand confers the benefits of clear resection margins, nodal staging and the ability to prognosticate and guide the decision for adjuvant therapy. This article sets out to review the histopathologic prognostic factors of MP and the various management and surveillance strategies.