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Inflammatory Bowel Disease V: Surgical Management01:21

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Related Experiment Video

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Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
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A Rectum-Specific Selective Resection Algorithm Optimizes Oncologic Outcomes for Large Nonpedunculated Rectal Polyps.

Neal Shahidi1, Sergei Vosko2, Sunil Gupta3

  • 1Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia; Division of Gastroenterology, St. Paul's Hospital, Vancouver, British Columbia, Canada; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association
|May 8, 2022
PubMed
Summary
This summary is machine-generated.

A new algorithm for selecting endoscopic resection techniques for large rectal polyps significantly reduced cancer detection after EMR. This selective resection algorithm (SRA) improves oncologic outcomes for large nonpedunculated rectal polyps (LNPRPs).

Keywords:
AdenomaCancerColonoscopyPolypSurgery

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Area of Science:

  • Gastroenterology
  • Endoscopic Surgery
  • Oncology

Background:

  • Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are key techniques for large (≥20 mm) nonpedunculated rectal polyps (LNPRPs).
  • A standardized algorithm for selecting between EMR and ESD for LNPRPs has been lacking.
  • Accurate polyp characterization and appropriate technique selection are crucial for optimal patient outcomes.

Purpose of the Study:

  • To evaluate the performance of a novel selective resection algorithm (SRA) for LNPRPs.
  • To compare the SRA with a universal EMR algorithm (UEA) in terms of oncologic outcomes and technical success.
  • To determine if the SRA can mitigate the risk of piecemeal resection of cancers in the rectum.

Main Methods:

  • A prospective observational study comparing SRA (August 2017-April 2021) with UEA (July 2008-July 2017) for LNPRPs.
  • The SRA guided ESD for polyps with features of superficial submucosal invasive cancer (SMIC) or high risk of SMIC, and EMR for others.
  • Outcomes assessed included SMIC after EMR, curative oncologic resection (R0), technical success, adverse events, and recurrence.

Main Results:

  • A total of 480 LNPRPs were analyzed (290 UEA, 190 SRA), with a median size of 40 mm.
  • SMIC after EMR was significantly lower with SRA (1.0%) compared to UEA (12.1%) (P=.001).
  • Curative oncologic resection rates were higher with SRA (33.3%) versus UEA (5.7%) (P=.010), with no significant differences in technical success or adverse events.

Conclusions:

  • A rectum-specific selective resection algorithm (SRA) optimizes oncologic outcomes for large nonpedunculated rectal polyps (LNPRPs).
  • The SRA effectively minimizes the risk of piecemeal resection of cancers.
  • This algorithm facilitates appropriate technique selection, improving the management of rectal polyps.