Management of colorectal polyp cancers

Abstract

INTRODUCTIONManagement of malignant colorectal polyps is controversial. The options are resection or surveillance. Resection margin status is accepted as an independent predictor of adverse outcome. However, the rate of adverse outcome in polyps with a resection margin of <1mm has not been investigated.METHODSA retrospective search of the pathology database was undertaken. All polyp cancers were included. A single histopathologist reviewed all of the included polyp cancers. Polyps were divided into three groups: clear resection margin, involved resection margin and unknown resection margin. Polyps were also analysed for tumour grade, morphology, Haggitt/Kikuchi level and lymphovascular invasion. Adverse outcome was defined as residual tumour at the polypectomy site and/or lymph node metastases in the surgical group and local or distant recurrence in the surveillance group.RESULTSSixty-five polyps (34 male patients, mean age: 73 years, range: 50–94 years) were included. Forty-six had clear polyp resection margins; none had any adverse outcomes. Sixteen patients had involved polyp resection margins and twelve of these underwent surgery: seven had residual tumour and two of these patients had lymph node metastases. Four underwent surveillance, of whom two developed local recurrence. Three patients had resection margins on which the histopathologist was unable to comment. All patients with a clear resection margin had no adverse outcome regardless of other predictive factors.CONCLUSIONSPolyp cancers with clear resection margins, even those with <1mm clearance, can be treated safely with surveillance in our experience. Polyp cancers with unknown or involved resection margins should be treated surgically.

The management of malignant polyps in colorectal cancer screening programmes: A retrospective Italian multi-centre study

“…Naqvi et al came to different conclusions and suggested that clear resection margins, even those with less than 1 mm of clearance, might be treated safely only with surveillance [19].…”

The Ueno method for substaging pT1 colorectal adenocarcinoma by depth and width measurement: an interobserver study

“…Data beyond the end of the whiskers are outliers and plotted as points. resection as a definitive procedure for early CRC is predicated by several factors: the ability to obtain complete resection, well or moderately differentiated adenocarcinomas, pathological evaluation of the entire intact specimen and the absence of lymphovascular invasion and tumour budding [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. These parameters highlight the importance of the pathologist and microscopic evaluation of the specimen.…”

“…The pathological assessment of the polypectomy specimen, from specimen handling to reporting, is therefore crucial to the decision-making about the best therapeutic option. Recommended pathology reporting guidelines include comment on: margin status, level/extent of invasion (Haggitt [3], Kikuchi [4] or Ueno [7] measurement), tumour differentiation, lymphovascular space invasion and tumour budding since these help the endoscopist and/or surgeon in polyp risk stratification [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. However, the use of these prognostic parameters is based on small studies and some of these have poor interobserver agreement [11,13,30].…”

Kolektomija po kolonoskopinės piktybinių polipų šalinimo procedūros ir netikėta T1 vėžio histologinė diagnozė

“…Most authors claim that a clear resection margin is anywhere from 1 mm [13] (as this definition was used in our study) to 2 mm [2,14]. According to Naqvi et al, even those with a <1mm clearance of cancer cells can be treated with surveillance [15].…”

“…There were no severe complications of grade III-IV or surgical mortalities. The median length of hospital stay was 12 days (range, [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22].…”