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Cutting Through the Debate: Surgical Resection Versus Surveillance-Based Approach for Kikuchi SM2/3 Colorectal Polyps
Izna Najam Syed1, Noem Najam Syed2, Lin Alkhiami3
1General Surgery, The Royal Wolverhampton NHS Trust, Wolverhampton, GBR.
Cureus
|December 29, 2025
Summary
For Kikuchi SM2 malignant colorectal polyps, surgical resection significantly reduces cancer recurrence and mortality compared to surveillance. This finding supports surgical management for better patient prognoses.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Colorectal Surgery
Background:
- Malignant colorectal polyps invading the submucosa require careful management.
- The Kikuchi classification system grades submucosal invasion (SM1-3) in sessile polyps.
- Deeper invasion (SM2-3) increases lymph node metastasis risk, often necessitating surgical resection.
Purpose of the Study:
- To compare the prognostic benefits of surveillance versus surgical resection for Kikuchi SM2/3 malignant colorectal polyps.
- To evaluate recurrence rates and case fatality between management strategies.
- To inform clinical decision-making for sessile malignant polyps.
Main Methods:
- Retrospective cohort study of patients from the UK National Bowel Cancer Screening Programme (2009-2023).
- Included sessile polyps with Kikuchi SM2 classification; excluded pedunculated polyps or unassessable classifications.
- Compared oncological outcomes (recurrence, mortality) between surveillance and surgical colectomy groups.
Main Results:
- Of 70 SM2 polyps, 23 underwent surgery and 47 surveillance.
- The surveillance group had significantly higher endoscopic and biochemical recurrence rates.
- Cancer-related mortality was significantly lower in the surgical group.
- Radiological recurrence was lower in the surgical group (not statistically significant).
Conclusions:
- Surgical management of Kikuchi SM2 malignant colorectal polyps yields superior prognostic outcomes.
- Prophylactic colectomy is associated with reduced cancer mortality and recurrence.
- Findings suggest surgeons consider surgical intervention for SM2/3 malignant polyps.
