The Malignant Polyp - When to Operate: The St. Mark’s Experience

The world literature on malignant polyps suggests that thoseremoved endoscopically with recognized favorable histological features for conservativemanagement have excellent prognoses without surgery. Many sessileor 'uncertainly removed' malignant polyps after endoscopic polypectomy alsoshow no evidence of residual cancer, suggesting that referral for surgical resectionis not invariably in the best interests of elderly or poor surgical risk patients. StMark's experience of five year follow-up of 62 patients with malignant polypsjudged 'completely excised' showed three cancer-related deaths (of uncertainprimary) in 78- to 81-year-old patients. Of 18 patients with malignant polyps'incompletely excised,' seven had no cancer found at surgery, 10 were wellwithout surgery and one died from carcinomatosis following delayed surgery.These generally encouraging results are further evidence that 'knee jerk surgery'for malignant polyps is inappropriate