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

Abstract

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.

Diagnostic performance for T1 cancer in colorectal lesions ≥10 mm by optical characterization using magnifying narrow‐band imaging combined with magnifying chromoendoscopy; implications for optimized stratification by Japan Narrow‐band Imaging Expert Team classification

“…This suggests that most NICE Type 2 lesions and JNET Type 2A lesions might be non‐invasive, irrespective of the use of magnification. A recent systematic review demonstrated that one‐third of surgical resections of benign tumors are indicated by fear of submucosal invasion 25 . As our recent study revealed that preoperative characterization could reduce redundant surgery for benign leisons, 26 JNET type 2A classification can be a good marker for non‐invasive lesions, similar to NICE Type 2 without magnified endoscopy.…”

Adverse events of colonoscopy in a colorectal cancer screening program with fecal immunochemical testing: a population-based observational study

“…An AE following the treatment of a large sessile polyp is attributed either to endoscopy or to surgery depending on the type of resection. Surgical resection-related morbidity-mortality is significantly higher than endoscopic polypectomy-related morbidity-mortality [26,27]. Consequently, if the rate of referral for surgery for benign polyps is high, the individual endoscopist's or CRC screening program's colonoscopy-related AE rate will be low while the overall AE rate will be high.…”

Management of large polyps in a colorectal cancer screening program with fecal immunochemical test: a population-based study

“…Furthermore, despite the higher morbidity-mortality rate of surgical resection, when the first-line endoscopists could not remove benign LPs themselves, they referred patients to a surgeon twice as often as to a more experienced endoscopist (8,14). This led to a non-negligible volume of surgeries for benign LPs, avoidable in 32% to 74% of cases if patients had been referred to expert endoscopists (13,14,21). Surgery was definitely unwarranted in more than 60% of our benign LP patients who were As previously reported, the risk of malignancy was three-fold and two-fold higher for LPs located in the rectum and sigmoid respectively compared with the rest of the colon (31,32).…”

“…In the US, they represented 25% of surgeries for colorectal neoplasia (13). Yet, the pooled 1-month complication and mortality rates of surgery for benign polyps are 24% and 0.7%, respectively, significantly higher than those of ER (perforation 1.5%, bleeding 6.5%, mortality 0.08%) (8,14). There Our aim was to analyze presentation, management and outcomes of colorectal LPs detected in the French CRC FIT screening program.…”