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Surgical or endoscopic management of malignant colon polyps
Author(s) -
Samuolis Nikas,
Samalavicius Narimantas E.,
Dulskas Audrius,
Markelis Rytis,
Lunevicius Raimundas,
Mickys Ugnius,
Ringeleviciute Ugne
Publication year - 2018
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.14846
Subject(s) - medicine , lymphovascular invasion , colorectal cancer , colectomy , adenocarcinoma , lymph node , tumor budding , metastasis , perineural invasion , lymph node metastasis , endoscopic mucosal resection , cancer , surgery , gastroenterology , oncology , endoscopy
Background To evaluate indications for colectomy in T1 polyps and possible risk factors for lymph node metastasis. Methods Between 2004 and 2017, 40 patients underwent colectomy after endoscopic removal of malignant polyps with T1 carcinoma. Resection was done based on at least one of the unfavourable histopathological criteria. We collected and prospectively studied histopathologic features, short‐term results and the benefit–risk balance. Complications were assessed by Clavien–Dindo classification. Results Twenty‐five patients (62.5%) underwent laparoscopic bowel resection. Twenty‐nine patients (63.0%) had more than two unfavourable criteria in the polyp that justified colorectal resection. Thirty‐five patients (76%) had G2 (moderately differentiated) cancer, 11 (24%) had G1 (well‐differentiated). Five patients (12.5%) had lymph node metastases and one (2.5%) had residual adenocarcinoma. All five patients with lymph node metastasis had G2 cancer. Nine patients (22.5%) had residual adenoma. Overall complications were identified in six (15.0%) patients. Oncologic benefit (or risk factors for lymph node metastasis) was significantly associated with polyp size ≥18 mm ( P = 0.006), lymphovascular invasion ( P = 0.05) and budding ( P = 0.02). Conclusions Female gender, lymphovascular invasion, desmoplastic reaction, criteria for surgery ≥2 and polyp size ≥18 mm were all in complex significant risk factors for lymph node metastasis in T1 colorectal cancer. Acting as a single factor, these variables had no effect to increased risk of metastasis.