A prospective case controlled study of the short‐term outcome following hemicolectomy for benign compared with malignant colonic polyps

Brigic, A; Ra, Chisei; Bassett, Paul; Clark, Susan; Kennedy, Robin H.

doi:10.1111/codi.12468

Cited by 6 publications

(8 citation statements)

References 26 publications

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“…Lastly, our data supports that endoscopic instead of surgical removal of large polyps should be considered first. Surgical removal of large polyps is associated with a considerable level of post-operative complications [ 37 ] and may not be ideal to remove synchronous or metachronous adenomas at multiple sites. In contrast, endoscopic resection allows for repetitive and multilocal removal.…”

Section: Discussionmentioning

confidence: 99%

Frequent co-occurrence of high-grade dysplasia in large flat colonic polyps (>20 mm) and synchronous polyps

et al. 2015

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BackgroundLarge colonic polyps are associated with advanced dysplasia, but prevalence and characteristics of synchronous polyps in patients with large flat colonic polyps are poorly investigated. This study aims to characterize clinicopathological features of large flat colonic polyps and their impact on occurrence and characteristics of synchronous polyps.MethodsA total of 802 patients that underwent endoscopic mucosal resection (EMR) of flat colonic polyps >20 mm from 2003 to 2014 in an academic endoscopy unit were retrospectively analyzed for size, location and histology of large polyps and synchronous polyps.ResultsAverage size of large polyps was 34.1 mm (range 20–150 mm, standard deviation 16.1 mm). Histology included 52.5 % adenomas with low-grade dysplasia (LGD), 26.7 % with high-grade dysplasia (HGD), 9.6 % serrated polyps and 11.2 % adenocarcinomas. The majority of large polyps were localized in the proximal colon (61 %). 72.2 % of adenocarcinomas were found in the distal colon, while 80.5 % of all serrated polyps were detected in the proximal colon. Increase in polyp size, advanced age and location in the distal colon were associated with presence of HGD/adenocarcinoma in large polyps, as identified by multivariate analysis. Synchronous polyps were detected in 67.2 % of patients undergoing complete colonoscopy during EMR. Presence of HGD/adenocarcinoma in the large polyp, localization of any synchronous polyp in the rectosigmoid colon and occurrence of multiple synchronous polyps were associated with presence of HGD/adenocarcinoma in synchronous polyps.ConclusionsSynchronous polyps are frequently found in patients with large flat colonic polyps. The prevalence of synchronous polyps with high grade dysplasia is highest in patients with large flat polyps containing HGD/adenocarcinoma.Electronic supplementary materialThe online version of this article (doi:10.1186/s12876-015-0312-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Frequent co-occurrence of high-grade dysplasia in large flat colonic polyps (>20 mm) and synchronous polyps

et al. 2015

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“…Polyp location was the most common reason for referral in three studies, all reporting that the right-sided colon was the most common location for referral [19 -21]. In the other two studies, polyp size was the main reason for referral [18,22], with a median polyp size of 4.0 cm (interquartile range 2.5 -5.4 cm) [22] and a mean polyp size of 3.8 cm (standard deviation 1.9 cm) [18]. Overall, polyp size was reported in 21 of the 26 studies as median, mean, ranges, or categories.…”

Section: Referral Rate and Indications For Surgerymentioning

confidence: 99%

“…2). In studies that used a categorization for polyp size, the majority of the polyps that were referred for surgery were > 2 cm [17, 22 -24], and in the studies that reported on median polyp sizes, sizes ranged from 1.8 cm to 4.0 cm [19,20,22,25] (Table 1s).…”

Section: Referral Rate and Indications For Surgerymentioning

confidence: 99%

Outcomes of surgical resections for benign colon polyps: a systematic review

et al. 2019

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Background Not all benign colonic polyps are suitable for endoscopic resection, although criteria for endoscopic non-resectability vary worldwide. Clinical decision-making largely depends on endoscopic treatment options, as well as postoperative risks after surgical resection. This systematic review aimed to determine postoperative outcomes and the characteristics of surgically resected benign colonic polyps. Methods MEDLINE, EMBASE, and the Cochrane Library were searched for studies investigating the outcomes of surgical resection for benign colonic polyps since 1980. Studies were considered eligible when at least one postoperative outcome (morbidity and/or mortality) was reported. Meta-analyses were conducted for the primary outcome measures (morbidity and mortality) for studies that included patients only after the year 2000. Results Of the 4210 studies retrieved, 26 studies describing 139 897 patients were included. The most common indications for surgical resection were polyp location in the right-sided colon, non-pedunculated morphology, and large polyp size. The pooled 1-month complication and mortality rates of studies that included patients after the year 2000 were 24 % (95 % confidence interval [CI] 15 % – 36 %) and 0.7 % (95 %CI 0.6 % – 0.8 %), respectively. Conclusion The postoperative morbidity and mortality after colonic resection for benign polyps are substantial. Referral to an advanced interventional endoscopist should be considered before referral for surgery to evaluate the possibilities for endoscopic treatment of large, non-pedunculated, and/or colonic polyps in difficult locations without suspicion of submucosal malignant invasion.

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“…As mentioned in the introduction, Brigic et al [ 6 ] compared outcomes following segmental colectomy for benign and malignant colonic polyps. The fact that colectomy for benign disease was shown to cause significant morbidity in at least one-third of patients in their study should in their opinion provide further impetus to develop alternative, less invasive treatment options for this growing group of patients.…”

Section: Discussionmentioning

confidence: 99%

“…However, a more radical mesenteric resection is generally associated with increased morbidity and mortality compared to a smaller resection, and these complications should therefore be weighed against the chance of preventing cancer [ 5 ]. Brigic et al [ 6 ] remarked that clinical outcomes following oncologic resection for benign colonic polyps are poorly documented. Their prospective case controlled study showed similar postoperative complication rates after colonic resections for benign and malignant colonic polyps (46 and 31%, respectively).…”

Section: Introductionmentioning

confidence: 99%

The impact of the national bowel screening program in the Netherlands on detection and treatment of endoscopically unresectable benign polyps

et al. 2017

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BackgroundIn January 2014, a national bowel cancer screening program started in the Netherlands. The program is being implemented in phases until 2019. Due to this program, an increase in patients referred for a colorectal resection for benign, but endoscopically unresectable polyps, is expected. So far, most resections are performed according to oncological principles despite no pre-operative histological diagnosis of malignancy. The aim of this study was to analyze the increase in referred patients during the first year of the screening program and to compare pathological results and clinical outcome of resections of patients undergoing resection for benign polyps before and after implementation of screening.MethodsPatients referred for colorectal resection without biopsy-proven cancer between January 2009 and January December 2014 were identified from a prospectively maintained database. Patients with endoscopically macroscopic features of carcinoma were excluded.ResultsSeventy-six patients were included. Forty-seven patients (61.8%) were operated on in the 5 years prior to implementation of the screening program, and 29 patients (38.2%) were operated during the first year of implementation of the screening program. The overall malignancy rate before the introduction of the program was 14.1 and 6.6% after it had started (p = .469). All resections were performed laparoscopically; the conversion rate was 3.9% (n = 3). The overall mortality rate was 2.7% (n = 2), major complications (Clavien–Dindo > 3b) occurred in 11.8% (n = 9) of patients. The anastomotic leakage rate was 3.9% (n = 3).ConclusionsThe number of patients referred for benign polyps tripled after introduction of the screening program. With an overall major morbidity and mortality rate of 11.8%, it seems valid to discuss whether an endoscopic excision with advanced techniques with or without laparoscopic assistance would be preferable in this patient group, accepting a 6.6% reoperation rate for additional oncological resection with lymph node sampling in patients in whom a malignancy is found on histological analysis of the complete polyp.

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A prospective case controlled study of the short‐term outcome following hemicolectomy for benign compared with malignant colonic polyps

Abstract: Complications following hemicolectomy for BCP or CC are not significantly different. The results of the study provide further impetus to develop local full thickness colonic excision for benign colonic lesions as an alternative to major surgery.

Cited by 6 publications

References 26 publications

Frequent co-occurrence of high-grade dysplasia in large flat colonic polyps (>20 mm) and synchronous polyps

Frequent co-occurrence of high-grade dysplasia in large flat colonic polyps (>20 mm) and synchronous polyps

Outcomes of surgical resections for benign colon polyps: a systematic review

The impact of the national bowel screening program in the Netherlands on detection and treatment of endoscopically unresectable benign polyps

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