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Cancer incidence lower than expected in patients with large colorectal polyps
Patients with large colorectal polyps presented with a lower incidence of cancer than previously thought, leading researchers to conclude that colon-sparing advanced endoscopic techniques should be considered over traditional bowel resection in these patients, according to the results of a retrospective study.
“Currently a majority of patients undergo colon resections for large polyps that don’t harbor any cancer cells, which means in many cases a person’s colon is being removed for noncancerous reasons, based on subjective criteria,” Emre Gorgun, MD, FACS, FASCRS, a staff surgeon in the department of colorectal surgery at the Cleveland Clinic, said in a press release. “Our study is a real eye-opener; it’s the first step showing the low incidence of cancer in these large polyps, which is not as previously thought.”
Emre Gorgun
Gorgun and colleagues evaluated medical records for all patients who underwent colectomy for endoscopically unresectable colonic polyps at the Cleveland Clinic between 1997 and 2012 to estimate their cancer risk (n = 439; 50.1% men; median age, 67 years). They excluded patients with preoperative cancer diagnoses, inherited polyposis syndrome, inflammatory bowel disease and synchronous pathology requiring surgery. All included patients had polyps that were not diagnosed as cancerous before their surgery.
Thirty-seven patients (8.4%) were found to have cancer in the final pathology report.
“The significant finding of this research is that only 8% of patients who underwent colectomy for a large, apparently benign polyp had cancer, which means that 92% of patients had their colon removed for noncancerous reasons,” Gorgun said in the press release. “But colon resection doesn’t come for free — it’s a major abdominal operation associated with the risk of serious adverse events.”
Eighty-three patients (18.9%) had complications within 30 days of surgery, with similar complication rates between patients with and without cancer, the most common of which were postoperative ileus and wound infection.
“These findings suggest that we need to transform our surgical approach to ensure we better serve each patient. In a patient with an endoscopically unresectable colorectal polyp that looks benign, a more conservative, organ-sparing approach to removing them is usually safe,” Gorgun said in the press release. “Our results suggest that advanced endoscopic techniques,” — such as endoscopic mucosal resection or endoscopic submucosal dissection — “or a laparoscopic-assisted approach should be considered if there is not high suspicion for cancer.” – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.