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Colorectal Dis. 2013 Feb;15(2):169-76. doi: 10.1111/j.1463-1318.2012.03130.x.

Management and short-term outcome of malignant colorectal polyps in the north of England(1).

Author information

  • 1NORCCAG (NORthern Colorectal Cancer Audit Group), Wansbeck General Hospital, Northumberland, UK. m.gill@nhs.net

Abstract

AIM:

Management of malignant colorectal polyps (MCP) is contentious, with no randomized controlled trials comparing endoscopic with surgical management. This study reviews the management and outcomes of MCPs across a UK region.

METHOD:

Patients with a malignant polyp were identified using the NORCCAG (NORthern Colorectal Cancer Audit Group) database between April 2006 and July 2010. All histopathology reports and follow-up procedures were reviewed.

RESULTS:

Of 386 patients identified, 165 (42.7%) had the polyp biopsied and 221 (57.3%) had an endoscopic local excision (37 piecemeal excision, 184 polypectomy). All patients having an endoscopic biopsy underwent surgery. 103 (46.6%) having a local excision had follow-up surgery, of whom 79 (76.7%) had no residual cancer. Of the 118 patients managed endoscopically, none had residual cancer on follow-up endoscopy. The 21 (5.4%) Dukes C cancers were associated with Kikuchi SM3/Haggitt 4 lesions (χ(2) =10.85, P=0.005) and lesions with an involved/unsure excision margin (χ(2) =7.44, P=0.017). Predictors of finding residual tumour at surgery after local excision were Kikuchi SM3/Haggitt Level 4 (χ(2) =17.07, P<0.001) and an involved/unsure excision margin (χ(2) =20.45, P<0.001). An excision margin >0 mm was associated with the finding of no residual tumour (χ(2) =25.21, P<0.001). There was no difference in survival between surgical and endoscopic management (χ(2) =0.634, P=0.426) after a mean follow-up of 25.1 months.

CONCLUSION:

Endoscopic management of a subgroup of MCPs appears safe. A clear resection margin (>0 mm) appears sufficient to avoid surgery, except in locally advanced lesions (Kikuchi 3/Haggitt 4) which have a greater risk of residual cancer at surgery and lymph node metastasis.

© 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.

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PMID:
22709241
[PubMed - indexed for MEDLINE]
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