Colectomy for Endoscopically Unresectable Polyps

Bertelson, Noelle L.; Kalkbrenner, Kristen A; Merchea, Amit; Dozois, Eric J.; Landmann, Ron G.; Petris, Giovanni De; Young‐Fadok, Tonia M.; Etzioni, David A.

doi:10.1097/dcr.0b013e3182695115

Cited by 53 publications

(42 citation statements)

References 20 publications

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“…One might assume this rate to be higher in other clinics, as our centre is a TIEC with large experience in removing large adenomas endoscopically. The distribution of nonmalignant polyps referred for surgery in this study revealed a majority of polyps located on the right side, in accordance with the findings in other series of laparoscopic colectomy for polyps . This may reflect the reluctance of endoscopists to resect large and difficult polyps in the right colon because of the fear of complications such as perforation of the relatively thin right colonic wall .…”

Section: Discussionsupporting

confidence: 90%

Introduction of a colorectal cancer screening programme: results from a single‐centre study

et al. 2018

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Section: Discussionsupporting

confidence: 90%

Introduction of a colorectal cancer screening programme: results from a single‐centre study

et al. 2018

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“…In the literature review by Bertelson et al [23], the proportion of cancer found in surgically treated polyps ranged from 0 to 36%. The 44.4% proportion of operative specimens with changes of malignancy or pre-malignancy in this series demonstrated good case selection by attending physicians and justified the volume of operations performed.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Morbidity and Mortality among Veterans Health Administration Patients Undergoing Surgical Resection for Large Bowel Polyps (Bowel Resection for Polyps)

2013

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Background: Large bowel polyps with malignant characteristics or those that are too large to remove colonoscopically may require bowel resection. Method: We performed a retrospective review of 126 Veterans Health Administration patients who underwent elective resections for colonoscopically unresectable colorectal polyps over a 10-year period. We evaluated the association of patient characteristics and operative management on the composite outcome of 30-day postoperative morbidity and mortality. Results: 98% of patients were males. Mean age was 65.1 years. Most patients had comorbidities, including cardiac or vascular disease (47.4%), diabetes mellitus (54%), and tobacco (41%) or alcohol (32.5%) use. The majority (85.7%) of patients were considered to be in American Society of Anesthesiologists (ASA) physical status classifications III and IV. 92% of resections were completed via laparotomy. Thirty-day postoperative morbidity and mortality occurred among 40 (31.7%) patients. Fifty-six patients (44.4%) had operative specimens with malignant features. The only comorbidity statistically associated with 30-day morbidity and mortality was body mass index >30. Conclusion: Approximately one third of patients had significant postoperative morbidity or mortality. Clinical pathways chosen to treat colonoscopically unresectable polyps should be tailored to patients' conditions and the characteristics of their colorectal lesions.

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“…Tubulo-villous adenomas are at intermediate risk (22%). One recent study, however, did not identify size and histological sub-type as risk factors for development of cancer in polyps [8]. By definition, all types of adenomas exhibit some degree of dysplasia, meaning abnormal glandular architecture and damaged intracellular structures.…”

Section: Neoplastic Colorectal Polypsmentioning

confidence: 99%

“…Nevertheless, it is important to note that a partial colectomy for removing a polyp that is not amenable to colonoscopic resection is potentially a procedure for treating cancer. A recent large-scale study (750 patients) actually found that the incidence of cancer in patients undergoing colectomy for an irretrievable polyp is 17.7% [8]. Multivariate analysis identified two risk factors for the polyps harboring cancer: polyp location at the left colon and the presence of high grade dysplasia.…”

Section: Treatment Of Neoplastic Colonic Polypsmentioning

confidence: 99%

Colorectal polyps and polyposis syndromes

Shussman

Wexner

2014

Gastroenterology Report

174

122

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A polyp is defined as any mass protruding into the lumen of a hollow viscus. Colorectal polyps may be classified by their macroscopic appearance as sessile (flat, arising directly from the mucosal layer) or pedunculated (extending from the mucosa through a fibrovascular stalk). Colorectal polyps may also be histologically classified as neoplastic or as non-neoplastic (hyperplastic, hamartomatous, or inflammatory). The neoplastic polyps are of primary importance because they harbor a malignant potential, which represents a stage in the development of colorectal cancer. For this reason, it is essential to identify these polyps at a sufficiently early stage, when a simple outpatient procedure to remove them can interrupt the development of colorectal cancer and prevent disease and death. When invasive carcinoma arises in a polyp, careful consideration must be given to ensuring the adequacy of treatment. Although most neoplastic polyps do not evolve into cancer, it is well accepted that the majority of colorectal carcinomas evolve from adenomatous polyps; the sequence of events leading to this transformation is referred to as the adenoma-to-carcinoma sequence.The presence of a systemic process that promotes the development of multiple gastro-intestinal polyps is termed ‘polyposis’. Hereditary gastro-intestinal polyposis syndromes account for approximately 1% of all cases of colorectal cancer and are associated with a broad spectrum of extra-colonic tumors. Early detection and accurate classification of these syndromes are essential, in order to initiate a surveillance program for the early detection of cancer. Several polyposis syndromes have been described, each having its own genetic basis and characteristic polyp distribution, clinical presentation, and malignancy risk.Diagnostic modalities and treatment options for neoplastic polyps—as well as the most prevalent polyposis syndromes—are reviewed below.

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Colectomy for Endoscopically Unresectable Polyps

Cited by 53 publications

References 20 publications

Introduction of a colorectal cancer screening programme: results from a single‐centre study

Introduction of a colorectal cancer screening programme: results from a single‐centre study

Postoperative Morbidity and Mortality among Veterans Health Administration Patients Undergoing Surgical Resection for Large Bowel Polyps (Bowel Resection for Polyps)

Colorectal polyps and polyposis syndromes

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