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Published on: October 16, 2013
A structured conversion score to guide oncologic colectomy during combined endoscopic-laparoscopic surgery for
Mustafa Oruc1, Ozgur Aktas1, Metincan Erkaya1
1Department of Colorectal Surgery, Cleveland Clinic, Digestive Disease and Surgery Institute, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
Surgical Endoscopy
|August 6, 2026
Summary
Managing complex colonic polyps with benign biopsies is challenging. A new CELS-OC score predicts conversion to oncologic colectomy (OC) and malignancy, aiding organ-preserving decisions.
Area of Science:
- Colorectal surgery
- Gastroenterology
- Surgical oncology
Background:
- Management of complex colonic polyps with benign preoperative biopsies presents challenges, especially when endoscopic resection is difficult or oncologic risk is unclear.
- Combined endoscopic-laparoscopic surgery (CELS) is an organ-preserving alternative to oncologic colectomy (OC), but lacks clear intraoperative decision-making criteria.
- This study aimed to identify predictors for conversion from CELS to OC and for malignant pathology, and to develop a risk score for intraoperative guidance.
Purpose of the Study:
- Identify predictors of conversion from CELS to OC.
- Identify predictors of malignant pathology in complex colonic polyps.
- Develop an intraoperative risk score to guide surgical decision-making and improve organ preservation while maintaining oncologic safety.
Main Methods:
- Retrospective cohort study of 70 patients treated between 2014 and 2024 with an endoscopy-first strategy for complex colonic polyps.
- Analysis of preoperative and intraoperative variables using Firth penalized logistic regression to identify predictors of conversion to OC and malignancy.
- Development and internal validation of a 10-point CELS-OC score and integration into an operative algorithm.
Main Results:
- Twenty-five patients (35.7%) required conversion to OC; 20 (28.6%) had final pathology revealing malignancy.
- Ulceration/depression, lesion size ≥40 mm, and the non-lifting sign were independently associated with OC conversion.
- Ulceration/depression predicted malignancy (aOR 13.07). The CELS-OC score showed strong discrimination for OC conversion (AUC 0.928) and malignancy (AUC 0.874).
Conclusions:
- Specific morphologic and intraoperative features predict conversion to OC and malignancy in complex colonic polyps with benign biopsies.
- The CELS-OC score provides a structured intraoperative framework to enhance organ-preserving selection and oncologic safety.
- External validation of the CELS-OC score is recommended.
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