Rate of residual disease after complete endoscopic resection of malignant colonic polyp Journal Article
| Authors: | Butte, J. M.; Tang, P.; Gonen, M.; Shia, J.; Schattner, M.; Nash, G. M.; Temple, L. K. F.; Weiser, M. R. |
| Article Title: | Rate of residual disease after complete endoscopic resection of malignant colonic polyp |
| Abstract: | BACKGROUND: Following polypectomy, colectomy is performed selectively to ensure complete clearance of neoplasia. OBJECTIVE: This study aimed to determine the risk factors associated with residual disease at colectomy following malignant polypectomy. DESIGN: This is a retrospective study. SETTING: This investigation took place at a tertiary teaching cancer center. PATIENTS: Consecutive patients undergoing polypectomy followed by colectomy from 1990 to 2007 were identified from a prospective database. MAIN OUTCOME MEASURES: Factors associated with residual disease at colectomy were associated with clinicopathologic features. RESULTS: Colectomy following polypectomy was performed in 143 patients: 127 with clear invasion of polyp submucosa (invasive disease), and 16 suspicious for submucosal invasion. Residual disease after colectomy was diagnosed in 27 (19%) of 143 patients. Disease was present in the colonic wall in 19 patients (13%): invasive in 16 (11%), and noninvasive in 3 (2.1%). Of the 16 patients with residual invasive disease at colectomy, 15 had clearly invasive disease at polypectomy and 1 was suspicious for invasive disease at polypectomy. Lymph node metastasis was noted in 10 (7.0%) patients. When analyzing patients with clearly invasive disease at polypectomy by margin status, residual invasive disease in the colon wall was noted in 8 of 50 (16%) with <1mm(positive) polypectomy margin, 7 of 33 (21%) with indeterminate polypectomy margin, and 0 of 44 with >= 1 mm (negative) polypectomy margin (p = 0.009). Nodal metastasis was associated with the presence of lymphovascular invasion (p = 0.01). LIMITATIONS: This study is limited by its retrospective nature and selection bias. CONCLUSIONS: Following malignant polypectomy, colectomy should be considered in medically fit patients if the polypectomy margin is positive (<= 1 mm) or unknown, or if lymphovascular invasion is present. |
| Keywords: | survival; adult; aged; aged, 80 and over; middle aged; survival analysis; retrospective studies; mortality; cancer staging; follow up; follow-up studies; lymph node metastasis; lymphatic metastasis; neoplasm staging; adenocarcinoma; colonic neoplasms; pathology; retrospective study; cancer invasion; minimal residual disease; neoplasm, residual; colonoscopy; colon tumor; colon resection; neoplasm invasiveness; colon polyp; colonic polyps; colectomy |
| Journal Title: | Diseases of the Colon and Rectum |
| Volume: | 55 |
| Issue: | 2 |
| ISSN: | 0012-3706 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2012-02-01 |
| Start Page: | 122 |
| End Page: | 127 |
| Language: | English |
| ACCESSION: | WOS:000299165000003 |
| DOI: | 10.1097/DCR.0b013e3182336c38 |
| PROVIDER: | wos |
| PUBMED: | 22228153 |
| Notes: | --- - Article; Proceedings Paper - Annual Meeting of the American-Society-of-Colon-and-Rectal-Surgeons - MAY 14-18, 2011 - Vancouver, CANADA - "Source: Wos" |
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