Multidisciplinary team-guided combined endoscopic laparoscopic surgery for complex colonic lesions: a single-center...

Combined endoscopic laparoscopic surgery (CELS) is a minimally invasive alternative treatment for complex colonic polyps that can reduce surgical overtreatment. We report implementing a standardized treatment strategy with patients selected for CELS procedures via multidisciplinary team (MDT) conferences.

This observational cohort study included 97 consecutive patients treated with CELS between 2016 and 2022. All cases were discussed by either a benign or malignant MDT. Two CELS techniques were employed: endoscopically assisted wedge resection (EA-WR) and laparoscopically assisted endoscopic mucosal resection (LA-EMR). Patients with suspected malignancies underwent step-up segmental resection (SR) if necessary. Primary outcomes were morbidity and mortality; secondary outcomes included adherence to MDT decisions, procedure durations, length of stay (LOS), histopathology, recurrence, and follow-up.

The approach decided by the MDT was unchanged in 81% of cases (79/97). Median age was 70 years and 43% were female. Lesions had a mean size of 31 mm and were predominantly located in the right colon. Technical success for lesion removal during the index procedure was 98% (95/97), with 93% completed by CELS alone. Median operative durations were shorter for EA-WR (52 min) and LA-EMR (73 min) than for SR (163 min, p < 0.001). Median LOS was 1 day for CELS and 5 days for SR (p < 0.001). Eleven patients (11.3%) experienced complications; four required re-interventions. Adenocarcinomas were found in 15 patients (15/97, 12.6%), with treatment individualized based on intraoperative and histological findings. The recurrence rate for benign lesions was 4%; these recurrences were exclusively in the LA-EMR group.

An MDT-guided strategy incorporating CELS, with optional intraoperative step-up, is an individualized and organ-preserving approach to managing complex colonic lesions that minimizes unnecessary surgical resections. This strategy has the potential to improve clinical decision-making and should be validated in multicenter settings.