Additional colectomy after endoscopic excision of malignant polyps: is it always necessary?

Management of malignant colonic polyps following endoscopic excision remains controversial. Surgery is recommended after incomplete excision and/or in the presence of recognized risk factors. The objective of this study was to evaluate the short and long-term results of surgery following endoscopic excision of malignant colon polyps.

We present a 6-year retrospective observational study, in a tertiary oncology center, analyzing all patients diagnosed with malignant colonic polyps after endoscopic excision, submitted to surgery between January 2015 and December 2020.

124 patients were included. Four underwent polypectomy of 2 malignant polyps at the same time. Of the 128 endoscopic excision specimens, 75% (n = 96) were located at the sigmoid colon and 80.5% (n = 103) demonstrated more than one histological risk factor, namely, deep submucosal invasion (DSI) - >1000 μm, tumor budding, histological grade 2 or 3, lymphatic, venous or perineural invasion. An R0 resection was achieved in 77 (60.16%) endoscopic specimens. Of these, 25 had a single histological risk factor, the majority of which (n = 19; 76%) presenting with DSI. Of these 25 patients (R0 with only one risk factor), none had residual disease in the surgical specimen (local or nodal), and none had recurrence of the disease.

The absence of disease in the surgical specimen after endoscopic excision in patients with an R0 endoscopic resection with a single risk factor, namely DSI, suggests that surgery can be spared in this subset of patients.