Endoscopic excision of synchronous large bowel polyps in the presence of colorectal carcinoma: is the fear of malignant cell implantation justified? A systematic review of the literature

Sheel, Andrea; Artioukh, D. Y.

doi:10.1111/codi.12930

Cited by 8 publications

(6 citation statements)

References 59 publications

(78 reference statements)

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“…These findings are also consistent with the systematic review by Sheel et al [ 9 ]. In this systematic review, the only identified literature that studied human subjects was an isolated case report [ 10 ].…”

Section: Discussionsupporting

confidence: 93%

“…In turn, such an approach subjects patients to a further endoscopic procedure that could have been avoided had a polypectomy been performed during the initial diagnostic colonoscopy. This formed the premise of an earlier systemic review by Sheel et al [ 9 ]. In this review, articles were included if they described human or mammalian models related to colorectal cancer cell implantation on normal and damaged colonic mucosa, such as polypectomy sites.…”

Section: Introductionmentioning

confidence: 87%

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Synchronous polypectomy during endoscopic diagnosis of colorectal cancer – is the risk of tumour implantation at the polypectomy site significant?

Tan

Chen

et al. 2018

BMC Gastroenterol

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BackgroundSynchronous polypectomy in colonic malignancies is contentious due to the perceived risks of tumour implantation at polypectomy sites (PS). We assess the risks of tumour implantation after synchronous polypectomy.MethodsAn analysis of all endoscopies for cancer that were accompanied by synchronous polypectomies from 2005 to 2009 was performed. The incidence of metachronous colorectal cancers located at the same segment of a previous PS was the surrogate for tumour implantation. Data on patient demographics, tumour and polyp location(s) and follow-up outcomes were extracted. The rate of metachronous lesions at the same segment of a previous PS between patients who had all synchronous PS resected (Group A) and patients with PS left in-situ (Group B) were compared.ResultsTwo hundred and eighty-four patients had synchronous polypectomy performed during their initial endoscopy for cancer. Three patients were lost to follow-up and, in the remaining 281 patients, 87 (31.0%) were in Group A while 194 (69%) were in Group B. Median age, gender, tumour location, tumour stage, and pathological characteristics were similar between both groups. 2 (0.7%) patients developed local recurrences. Six (2.1%) patients developed metachronous lesions, four of which were located at the same segment where synchronous polypectomy was previously performed. The rates of metachronous lesions at the PS in groups A and B were similar at 1.1% (1/87) and 1.5% (3/194), respectively (p = 0.795).ConclusionMalignant implantation after synchronous polypectomy in the setting of a newly diagnosed cancer remains unproven. Even if tumor implantation did occur, the incidence is likely low.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 87%

Synchronous polypectomy during endoscopic diagnosis of colorectal cancer – is the risk of tumour implantation at the polypectomy site significant?

Tan

Chen

et al. 2018

BMC Gastroenterol

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“…13,14 Moreover, the experiments conducted do not exclude possibilities of tumor transmission other than working channel contamination, such as exfoliation of cancer cells passively being taken up into biopsied or polypectomy site tissue. 7 Studies on tumor regrowth based on exfoliated cells performed in rats showed that colon cancer cells have the ability to regrow on damaged mucosa in a minority of cases, whereas an intact mucosa was seen to be completely resistant. 15 This suggests that some extent of mucosal injury is necessary for impaction of cancer cells.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 Yet, the risk of spontaneous tumor seeding, that is, implantation of tumor cells in damaged mucosa when polypectomy or biopsy is performed in the presence of CRC elsewhere in the colorectum, is estimated to be low. 7 However, the possibility of mechanical tumor seeding during colonoscopy, involving iatrogenic implantation of tumor cells in damaged mucosa, has never been explored.…”

Section: Background and Aimsmentioning

confidence: 99%

Tumor Seeding During Colonoscopy as a Possible Cause for Metachronous Colorectal Cancer

et al. 2019

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“…Second, filiform polyposis was formed by an inflammation of colon diverticulitis; then the obstruction caused an implantation of sigmoid colon adenocarcinoma to erosive mucosa of filiform polyposis. Colon adenocarcinoma rarely develops in the defective part of mucosa [18]. Third, collision between sigmoid colon adenocarcinoma and the malignant transformation of filiform polyposis possibly occurred.…”

Section: Discussionmentioning

confidence: 99%

Filiform polyposis with sigmoid colon adenocarcinoma: a case report

Okuno¹,

Kanazawa²,

Kishi³

et al. 2019

surg case rep

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BackgroundFiliform polyposis is a rare form of inflammatory polyposis, which is occasionally formed in the colon of patients with history of inflammatory bowel disease (IBD). It is characterized by presence of several to hundreds of slender, worm-like polyps in the colon lined by histologically normal colonic mucosa and often coalesce, resulting in a tumor-like mass. Filiform polyposis is most frequently associated with a post-inflammatory reparative process in patients with IBD history, and only cases of filiform polyposis occurring in patients without IBD history have been reported. Filiform polyposis has been considered as a benign inflammatory polyposis without any risk of dysplasia, while the possibility of carcinogenesis of inflammatory polyps is not fully excluded. To date, only three cases of filiform polyposis coexisting with dysplasia have been reported.Case presentationA 59-year-old male patient with no past medical history of IBD underwent laparoscopic sigmoidectomy for obstructive filiform polyposis, which was associated with sigmoid colon adenocarcinoma. Based on the histological findings of the resected specimen, invasive sigmoid colon adenocarcinoma was surrounded by filiform polyposis, and adenocarcinoma also scattered uniformly on the surface of filiform polyposis. In immunohistochemistry, abnormal p53 expression was observed in adenocarcinoma, while it was not shown in mucosa on filiform polyposis.ConclusionsThis is the fourth case of filiform polyposis that is closely associated with colon dysplasia or adenocarcinoma based on histological findings. However, immunohistochemical findings did not support the theory that inflammation initiates adenocarcinoma in filiform polyposis like IBD. Hence, further immunohistochemical and genetic analyses are needed to clarify the association between filiform polyposis and carcinogenesis.

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Endoscopic excision of synchronous large bowel polyps in the presence of colorectal carcinoma: is the fear of malignant cell implantation justified? A systematic review of the literature

Abstract: The topic of colorectal cancer seeding following endoscopic procedures has received little attention. This review suggests that in the presence of a proximal colonic carcinoma there is a negligible risk of malignant implantation if a more distal polyp is endoscopically excised.

Cited by 8 publications

References 59 publications

Synchronous polypectomy during endoscopic diagnosis of colorectal cancer – is the risk of tumour implantation at the polypectomy site significant?

Synchronous polypectomy during endoscopic diagnosis of colorectal cancer – is the risk of tumour implantation at the polypectomy site significant?

Tumor Seeding During Colonoscopy as a Possible Cause for Metachronous Colorectal Cancer

Filiform polyposis with sigmoid colon adenocarcinoma: a case report

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