Endoscopic polypectomy of the large bowel: management of cancer-bearing polyps

From January 1974 to May 1979, among 2,338 endoscopic examinations of the large bowel, 184 polypectomies were performed. Forty-two cases of familial polyposis coli were excluded from this study. Of the remaining 142 cases, 21 had cancer foci: fourteen were mucosally confined carcinomas, and seven submucosally invading carcinomas. Endoscopic polypectomy was considered a radical treatment for the former and not satisfactory for the latter. Therefore macroscopic type of polyp, location of carcinoma in the polyp, and lymphatic and venous permeation were the main criteria evaluated for the strategy of treatment in cases of submucosally invading carcinoma-bearing polyps. Radical resections are necessary in cases of semipedunculated polyp with carcinoma located near the base, and in cases of pedunculated polyps with carcinoma extending to the stalk. However, as general criteria for the management of submucosally invading carcinoma-bearing polyps have not yet been established, radical resections are indicated in cases which do not fit the generally accepted criteria, in order to attempt a curative treatment. Endoscopic polypectomy therefore seems to be of great value in the early detection of colorectal cancers and their treatment.