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The Role of Tumor Location on Endoscopic and Surgical Management of Malignant Colon Polyps

  • 0Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
Annals of Surgical Oncology +

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July 30, 2024

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July 30, 2024

View abstract on PubMed

Summary

This summary is machine-generated.

Proximal colon polyps treated with endoscopic polypectomy have worse survival rates. Surgical colectomy mitigates this survival disparity, suggesting proximal location is a high-risk feature for endoscopic treatment.

Area Of Science

  • Gastroenterology
  • Surgical Oncology
  • Oncology

Background

  • Endoscopic polypectomy is a definitive treatment for early-stage (pathologic T1) colon polyps.
  • Previous research indicates poorer outcomes for proximal versus distal advanced colon cancers.
  • Limited data exists on tumor location's prognostic impact for pathologic T1 (pT1) colon polyps.

Purpose Of The Study

  • To investigate the prognostic impact of tumor location (proximal vs. distal) on survival outcomes for patients with pT1 colon adenocarcinoma.
  • To compare outcomes between endoscopic polypectomy and partial colectomy for pT1 colon tumors based on location.

Main Methods

  • Retrospective cohort study utilizing the Surveillance, Epidemiology, and End Results (SEER) database (2000-2019).
  • Included adult patients diagnosed with T1NxMx or T1N0-3M0/x colon adenocarcinoma.
  • Analyzed outcomes for patients treated with endoscopic polypectomy versus partial colectomy.

Main Results

  • Proximal pT1 colon polyps treated with endoscopic polypectomy showed significantly lower 5-year overall survival (64%) and cancer-specific survival (91%) compared to distal polyps (83% and 96%).
  • Multivariable analysis revealed a greater survival difference between proximal and distal polyps after endoscopic resection (HR 1.73) versus colectomy (HR 1.13).
  • Cancer-specific mortality was higher for proximal polyps after polypectomy (HR 1.94), but this disparity was not observed after colectomy (HR 1.09).

Conclusions

  • Proximal tumor location is an independent predictor of worse overall and cancer-specific survival following endoscopic polypectomy for pT1 colon cancer.
  • Partial colectomy mitigates the survival disadvantage associated with proximal tumor location compared to endoscopic treatment.
  • Proximal location should be considered a high-risk feature when evaluating endoscopic polypectomy for pT1 colon polyps.

Keywords:

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