Welcher endoskopisch abgetragene Kolonpolyp bedarf einer zusätzlichen onkochirurgischen Kolonresektion?

Abstract

Malignant colorectal polyps are defined as endoscopically removed polyps with cancerous tissue which has invaded the submucosa. In patients with favorable histological signs (low-risk malignant polyps) defined as cancer-free resection margin, lack of vessel invasion and no poorly differentiated cancer, polypectomy alone appears to be sufficient. On the other hand, the most important and independent risk factors for adverse outcome in patients with malignant polyps are incomplete polypectomy and a resection margin that is histologically not clearly cancer-free. Other histological risk factors such as venous and lymphatic invasion or poorly differentiated carcinoma (G3) are also associated with an increased risk for an adverse outcome, but only in combination. Consequently, all patients with such high-risk malignant polyps who are fit for operation should be submitted to surgery. In the small number of cases with one of the not independent risk factors (venous and lymphatic invasion or poorly differentiated carcinoma) in the absence of other unfavorable features, the indication for operation is relative and should be individually assessed on the basis of surgical risk.