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Rectum versus colon: should malignant polyps be treated differently?
Author(s) -
Solon J. Gemma,
Oliva Karen,
Farmer K. Chip,
Wang Wei,
Wilkins Simon,
McMurrick Paul J.
Publication year - 2021
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.16437
Subject(s) - medicine , rectum , rectal polyp , endoscopy , lymph node , retrospective cohort study , colonoscopy , colorectal cancer , surgery , cancer
Background The management of malignant colorectal polyps removed at endoscopy remains controversial with patients either undergoing surgical resection or regular endoscopic surveillance. Lymph node (LN) metastases occur in 6–16% of patients with malignant polyps. This study assessed the rate of LN metastases in patients undergoing surgical resection for malignant polyps removed endoscopically to determine if there is a difference in the rate of LN metastases between colonic and rectal polyps. Methods A retrospective review of a prospectively maintained database was performed from 2010 to 2018. All patients who underwent surgical resection following endoscopic removal of a malignant colorectal polyp were reviewed. Clinical data including patient demographics and tumour characteristics were examined. Results A total of 177 patients underwent surgical resection in the study period. The median age at diagnosis was 65 years (range 22–88 years) with females comprising 52% of the patient cohort ( n = 92/177). Polyps were located in the colon in 60.5% of cases with the remainder located in the rectum. The median number of LN harvested was 14 (range 0–44) with malignant LN (including a mesenteric tumour deposit) identified in 8.5% of resection specimens ( n = 15/177). Malignant LNs were retrieved in 5.5% of right‐sided tumours, 5.6% of left‐sided tumours and 12.9% of rectal tumours ( P = 0.090). Conclusion A small proportion of patients with malignant polyps removed endoscopically will have LN metastases. The results of this study suggest that the tumour location might be a useful predictive marker; however, a further study with increased patient numbers is required to properly establish this finding.