Polypectomy or colectomy? Management of 106 consecutively encountered colorectal polyps

Area of Science:

• Gastroenterology
• Surgical Oncology
• Endoscopic Procedures

Background:

• Malignant colorectal polyps present a treatment challenge, with sessile types typically requiring colectomy.
• Pedunculated malignant polyps, however, may be amenable to less invasive endoscopic removal.
• Accurate microscopic assessment is vital for determining polyp malignancy and guiding treatment decisions.

Purpose of the Study:

• To evaluate the efficacy of colonoscopic polypectomy for malignant colorectal polyps.
• To identify criteria for successful endoscopic management of malignant polyps.
• To review clinical outcomes of patients treated for malignant colorectal polyps.

Main Methods:

• Review of 106 consecutive malignant colorectal polyps over a 10-year period.
• Analysis of treatment modalities: colonoscopic polypectomy versus colectomy.
• Microscopic examination of resected polyp specimens, focusing on margins, lymphatics, and differentiation.

Main Results:

• 62 malignant polyps were successfully removed by colonoscopic polypectomy alone, with favorable outcomes.
• One patient with positive margins died from metastatic disease.
• 44 patients underwent colectomy, 26 of whom had prior colonoscopic polypectomy.

Conclusions:

• Colonoscopic polypectomy is a viable and effective treatment for selected malignant pedunculated colorectal polyps.
• Strict adherence to criteria, including clear margins and well-differentiated malignancy, is essential for curative endoscopic treatment.
• Careful patient selection and experienced technique are paramount for successful colonoscopic management of malignant polyps.