[The secondary prevention of colorectal carcinoma by polyp removal]

Colorectal adenomas are established precursor lesions of colorectal carcinoma. Molecular biologic investigations suggest a developing cycle from normal mucosa and adenoma to carcinoma via influence of oncogens and tumor suppressor genes. Polypectomy is supposed to reduce the colorectal cancer risk.

Studies published in this field until now were analysed and it was discussed whether consequent endoscopic polypectomy of colorectal adenomas adds to secondary prevention of colorectal carcinoma.

A variety of studies has shown that removing the precursors of colorectal carcinoma leads to a distinct reduction of colorectal carcinoma. A large American prospective study has confirmed these observations and has shown that compared to the expected incidence, found in large population studies, the risk of colorectal carcinoma can be reduced by up to 90%. As a consequence, besides complete polypectomy the regular follow-up is mandatory to detect and treat recurrent polyps.

Consequent endoscopic polypectomy of all colon adenomas which today usually is performed with a diathermy loop is a secondary prevention of colorectal carcinoma. The surveillance should be performed along the lines of the German Cancer Society.