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SURGICAL MANAGEMENT OF ENDOSCOPICALLY UNRESECTABLE COLORECTAL POLYPS

Year 2023, Volume: 86 Issue: 2, 130 - 137, 30.03.2023
https://doi.org/10.26650/IUITFD.1115321

Abstract

Objective: To define the management of colorectal polyps that were technically unsuitable for endoscopic removal. Materials and Methods: Between May 2010 and January 2019, 4886 polyps from 3822 of 16,996 colorectal endoscopies were analyzed. Of the total colorectal polyps, 135 (2.8%) were identified as endoscopically unresectable single polyps and examined in detail. Result: The rate of invasive colorectal cancer (CRC) in unresectable and resectable polyps was 26.7% and 1.7%, respectively (p<0.001). Unresectable polyps were more common in the ascending colon and cecum (p<0.001), but the potential to contain invasive CRC was greater in the sigmoid colon and rectum-located polyps (p=0.001). In addition, advancing age (p=0.014), increased polyp size (p=0.012), deep submucosal invasion (p<0.001), and the presence of lymphovascular invasion (p<0.001) were associated with the development of CRC. Unresectable polyps requiring surgery after non-curative endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) were found to have a significantly higher risk of containing CRC compared with polyps that underwent surgical resection primarily (p=0.002). In the multivariate model, advancing age (p=0.010) and detected deep submucosal invasion (p=0.002) were more associated with the development of CRC. Conclusion: The study suggests that oncologic surgery for polyps with deep submucosal invasion (particularly by EMR or ESD) that cannot be endoscopically resected in older patients should be considered carefully and, perhaps, without delay, primarily by abandoning repeated endoscopic resection attempts.

References

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  • 2. Pox CP, Altenhofen L, Brenner H, Theilmeier A, Von Stillfried D, Schmiegel W. Efficacy of a nationwide screening colonoscopy program for colorectal cancer. Gastroenterology 2012;142(7):1460-7. [CrossRef] google scholar
  • 3. Amin MB, Green FL, Edge SB, Compton CC, Gershenwald JE, Bookland RK, et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a populationbased to a more “personalized” approach to cancer staging. AJCA Cancer J Clin 2017;67(2):93-9. [CrossRef] google scholar
  • 4. Ferlitsch M, Reinhart K, Pramhas S, Wiener C, Gal O, Bannert C, Hassler M, Kozbial K, Dunkler D, Trauner M, Weiss W. Sex-specifc prevalence of adenomas, advanced adenomas, and colorectal cancer in individuals undergoing screening colonoscopy. JAMA 2011;306(12):1352-8. [CrossRef] google scholar
  • 5. Lambert R. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: november 30 to december 1, 2002. Gastrointest Endosc 2003;58(6):S3-43. [CrossRef] google scholar
  • 6. Kudo S, Hirota S, Nakajima T, Hosebe S, Kusaka H, Kobayashi T, Himori M, Yagyuu A. Colorectal tumours and pit pattern. J Clin Pathol 1994;47(10):880-5. [CrossRef] google scholar
  • 7. Eijsbouts QA, Heuff G, Sietses C, Meijer S, Cuesta MA. Laparoscopic surgery in the treatment of colonic polyps. Br J Surg 1999;86(4):505-8. [CrossRef] google scholar
  • 8. Miller K, Waye JD. Colorectal polyps in the elderly: what should be done? Drugs Aging 2002;19(6):393-404. [CrossRef] google scholar
  • 9. Church JM. Avoiding surgery in patients with colorectal polyps. Dis Colon Rectum 2003;46(11):1513-6. [CrossRef] google scholar
  • 10. Church JM. Experience in the endoscopic management of large colonic polyps. ANZ J Surg 2003;73(12):988-95. [CrossRef] google scholar
  • 11. Doniec JM, Lohnert MS, Schniewind B, Bokelmann F, Kremer B, Grimm H. Endoscopic removal of large colorectal polyps: prevention of unnecessary surgery? Dis Colon Rectum 2003;46(3):340-8. [CrossRef] google scholar
  • 12. Nusko G, Mansmann U, Altendorf-Hofmann A, Groitl H, Wittekind C, Hahn EG. Risk of invasive carcinoma in colorectal adenomas assessed by size and site. Int J Colorectal Dis 1997;12(5):267-71. [CrossRef] google scholar
  • 13. Muto T, Bussey HJ, Morson BC. The evolution of cancer of the colon and rectum. Cancer 1975;36:2251-70. [CrossRef] google scholar
  • 14. Shinya H, Wolff WI. Morphology, anatomic distribution and cancer potential of colonic polyps. Ann Surg 1979;190(6):679-83. [CrossRef] google scholar
  • 15. McDonald JM, Moonka R, Bell RH Jr. Pathologic risk factors of occult malignancy in endoscopically unresectable colonic adenomas. Am J Surg 1999;177(5):384-7. [CrossRef] google scholar
  • 16. Alder AC, Hamilton EC, Anthony T, Sarosi GA. Cancer risk in endoscopically unresectable colon polyps. Am J Surg 2006;192(5):644-8. [CrossRef] google scholar
  • 17. Lee EJ, Lee JB, Lee SH, Youk EG. Endoscopic treatment of large colorectal tumors: comparison of endoscopic mucosal resection, endoscopic mucosal resection-precutting, and endoscopic submucosal dissection. Surg Endosc 2012;26(8):2220-30. [CrossRef] google scholar
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  • 19. Al-Sukhni E, Attwood K, Gabriel EM, LeVea CM, Kanehira K, Nurkin SJ. Lymphovascular and perineural invasion are associated with poor prognostic features and outcomes in colorectal cancer: a retrospective cohort study. Int J Surg 2017;37:42-9. [CrossRef] google scholar
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  • 22. Poeschl EM, Pollheimer MJ, Kornprat P, Lindtner RA, Schiemmer A, Rehak P. Perineural invasion: correlation with aggressive phenotype and independent prognostic variable in both colon and rectum cancer. J Clin Oncol 2010;28(21): e358-60. [CrossRef] google scholar
  • 23. Hamilton ST, Rubio CA, Vogelstein B. Carcinoma of colon and rectum. In: Hamilton Sr, Aaltonen LA, editors. Pathology & genetics. Tumours of the digestive system, Lyon, France: World Health Organization Classification of Tumours, IARC Press; 2000. pp. 111-2. google scholar
  • 24. Tytherleigh MG, Warren BF, Mortensen NJ. Management of early rectal cancer. Br J Surg 2008;95(4):409-23. [CrossRef] google scholar
  • 25. Yeung JMC, Maxwell-Armstrong C, Acheson AG. Colonic tattooing in laparoscopic surgery-making the mark? Colorectal Dis 2009;11(5):527-30. [CrossRef] google scholar
  • 26. Yamaner S, Baykan A, Zorluoglu A, Geçim E, Terzi C. Colon ve rectum cancers. Turkish Colon ve Rectum Surgery Association 2010;181-95. google scholar
  • 27. Bertelson NL, Kalkbrenner KA, MercheaA, Dozois EJ, Landmann RG, De Petris G, et al. Dis Colon Rectum 2012;55(11);1111-6. [CrossRef] google scholar
  • 28. Buskermolen M, Naber SK, Toes-Zoutendijk E, van der Meulen MP, van Grevenstein WMU, van Leerdam ME, et al. Impact of surgical versus endoscopic management of complex nonmalignant polyps in a colorectal cancer screening program. Endoscopy 2022;54(9):871-80. [CrossRef] google scholar

ENDOSKOPİK OLARAK ÇIKARILAMAYAN KOLOREKTAL POLİPLERE CERRAHİ YAKLAŞIM

Year 2023, Volume: 86 Issue: 2, 130 - 137, 30.03.2023
https://doi.org/10.26650/IUITFD.1115321

Abstract

Amaç: Bu çalışma, endoskopik olarak çıkarılması teknik olarak uygun olmayan kolorektal poliplerin tedavisini tanımlamayı amaçladı. Gereç ve Yöntem: Mayıs 2010 ile Ocak 2019 tarihleri arasında 16,996 kolorektal endoskopiden 3,822’sinde 4,886 polip analiz edildi. Total kolorektal poliplerin 135’i (%2,8) endoskopik olarak çıkarılamayan tekli polip olarak tanımlandı ve detaylı olarak incelendi. Bulgular: Rezeke edilemeyen bir polipte invaziv kolorektal kanser (KRK) oranı %26,7 iken, rezeke edilebilir bir polipte bu oran %1,7 idi (p<0,001). Rezeke edilemeyen polipler çıkan kolon ve çekumda daha yaygındı (p<0,001), ancak invaziv KRK içerme potansiyeli sigmoid kolon ve rektum yerleşimli poliplerde daha fazlaydı (p=0,001). Ayrıca ilerleyen yaş (p=0,014), artmış polip boyutu (p=0,012), derin submukozal invazyon (p<0,001) ve lenfovasküler invazyon varlığı (p<0,001) KRK gelişimi ile ilişkiliydi. Küratif olmayan endoskopik mukozal rezeksiyon (EMR) veya endoskopik submukozal diseksiyon (ESD) sonrası ameliyat gerektiren rezeke edilemeyen poliplerin, primer olarak cerrahi rezeksiyon uygulanan poliplere kıyasla anlamlı derecede daha yüksek KRK içerme riskine sahip olduğu bulundu (p=0,002). Çok değişkenli modelde ilerleyen yaş (p=0,010) ve saptanan derin submukozal invazyon (p=0,002) KRK gelişimi ile daha fazla ilişkiliydi. Sonuç: Çalışma, yaşlı hastalarda endoskopik olarak rezeke edilemeyen derin submukozal invazyonlu (özellikle EMR veya ESD ile) polipler için onkolojik cerrahinin dikkatli bir şekilde düşünülmesi gerektiğini ve belki de gecikmeden, öncelikle tekrarlanan endoskopik rezeksiyon girişimlerinden vazgeçilmesi gerektiğini önermektedir.

References

  • 1. Kuipers EJ, William MG, Lieberman D, Seufferlein T, Sung JJ, Boelens PG, et al. Colorectal cancer Nat Rev Dis Primers 2015;5(1):15065. [CrossRef] google scholar
  • 2. Pox CP, Altenhofen L, Brenner H, Theilmeier A, Von Stillfried D, Schmiegel W. Efficacy of a nationwide screening colonoscopy program for colorectal cancer. Gastroenterology 2012;142(7):1460-7. [CrossRef] google scholar
  • 3. Amin MB, Green FL, Edge SB, Compton CC, Gershenwald JE, Bookland RK, et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a populationbased to a more “personalized” approach to cancer staging. AJCA Cancer J Clin 2017;67(2):93-9. [CrossRef] google scholar
  • 4. Ferlitsch M, Reinhart K, Pramhas S, Wiener C, Gal O, Bannert C, Hassler M, Kozbial K, Dunkler D, Trauner M, Weiss W. Sex-specifc prevalence of adenomas, advanced adenomas, and colorectal cancer in individuals undergoing screening colonoscopy. JAMA 2011;306(12):1352-8. [CrossRef] google scholar
  • 5. Lambert R. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: november 30 to december 1, 2002. Gastrointest Endosc 2003;58(6):S3-43. [CrossRef] google scholar
  • 6. Kudo S, Hirota S, Nakajima T, Hosebe S, Kusaka H, Kobayashi T, Himori M, Yagyuu A. Colorectal tumours and pit pattern. J Clin Pathol 1994;47(10):880-5. [CrossRef] google scholar
  • 7. Eijsbouts QA, Heuff G, Sietses C, Meijer S, Cuesta MA. Laparoscopic surgery in the treatment of colonic polyps. Br J Surg 1999;86(4):505-8. [CrossRef] google scholar
  • 8. Miller K, Waye JD. Colorectal polyps in the elderly: what should be done? Drugs Aging 2002;19(6):393-404. [CrossRef] google scholar
  • 9. Church JM. Avoiding surgery in patients with colorectal polyps. Dis Colon Rectum 2003;46(11):1513-6. [CrossRef] google scholar
  • 10. Church JM. Experience in the endoscopic management of large colonic polyps. ANZ J Surg 2003;73(12):988-95. [CrossRef] google scholar
  • 11. Doniec JM, Lohnert MS, Schniewind B, Bokelmann F, Kremer B, Grimm H. Endoscopic removal of large colorectal polyps: prevention of unnecessary surgery? Dis Colon Rectum 2003;46(3):340-8. [CrossRef] google scholar
  • 12. Nusko G, Mansmann U, Altendorf-Hofmann A, Groitl H, Wittekind C, Hahn EG. Risk of invasive carcinoma in colorectal adenomas assessed by size and site. Int J Colorectal Dis 1997;12(5):267-71. [CrossRef] google scholar
  • 13. Muto T, Bussey HJ, Morson BC. The evolution of cancer of the colon and rectum. Cancer 1975;36:2251-70. [CrossRef] google scholar
  • 14. Shinya H, Wolff WI. Morphology, anatomic distribution and cancer potential of colonic polyps. Ann Surg 1979;190(6):679-83. [CrossRef] google scholar
  • 15. McDonald JM, Moonka R, Bell RH Jr. Pathologic risk factors of occult malignancy in endoscopically unresectable colonic adenomas. Am J Surg 1999;177(5):384-7. [CrossRef] google scholar
  • 16. Alder AC, Hamilton EC, Anthony T, Sarosi GA. Cancer risk in endoscopically unresectable colon polyps. Am J Surg 2006;192(5):644-8. [CrossRef] google scholar
  • 17. Lee EJ, Lee JB, Lee SH, Youk EG. Endoscopic treatment of large colorectal tumors: comparison of endoscopic mucosal resection, endoscopic mucosal resection-precutting, and endoscopic submucosal dissection. Surg Endosc 2012;26(8):2220-30. [CrossRef] google scholar
  • 18. Cranley JP, Petras RE, Carey WD, Paradis K, Sivak MV. When is endoscopic polypectomy adequate therapy for colonic polyps containing invasive carcinoma? Gastroenterology 1986;91(2):419-27. [CrossRef] google scholar
  • 19. Al-Sukhni E, Attwood K, Gabriel EM, LeVea CM, Kanehira K, Nurkin SJ. Lymphovascular and perineural invasion are associated with poor prognostic features and outcomes in colorectal cancer: a retrospective cohort study. Int J Surg 2017;37:42-9. [CrossRef] google scholar
  • 20. Huh JW, Kim HR, Kim YJ. Prognostic value of perineural invasion in patients with stage II colorectal cancer. Ann Surg Oncol 2010;17(8): 2066-72. [CrossRef] google scholar
  • 21. Betge J, Pollheimer MJ, Lindtner RA, Kornprat P, Schiemmer A, Rehak P. Intramural and extramural vascular invasion in colorectal cancer: prognostic significance and quality of pathology reporting. Cancer 2012;118(3):628-38. [CrossRef] google scholar
  • 22. Poeschl EM, Pollheimer MJ, Kornprat P, Lindtner RA, Schiemmer A, Rehak P. Perineural invasion: correlation with aggressive phenotype and independent prognostic variable in both colon and rectum cancer. J Clin Oncol 2010;28(21): e358-60. [CrossRef] google scholar
  • 23. Hamilton ST, Rubio CA, Vogelstein B. Carcinoma of colon and rectum. In: Hamilton Sr, Aaltonen LA, editors. Pathology & genetics. Tumours of the digestive system, Lyon, France: World Health Organization Classification of Tumours, IARC Press; 2000. pp. 111-2. google scholar
  • 24. Tytherleigh MG, Warren BF, Mortensen NJ. Management of early rectal cancer. Br J Surg 2008;95(4):409-23. [CrossRef] google scholar
  • 25. Yeung JMC, Maxwell-Armstrong C, Acheson AG. Colonic tattooing in laparoscopic surgery-making the mark? Colorectal Dis 2009;11(5):527-30. [CrossRef] google scholar
  • 26. Yamaner S, Baykan A, Zorluoglu A, Geçim E, Terzi C. Colon ve rectum cancers. Turkish Colon ve Rectum Surgery Association 2010;181-95. google scholar
  • 27. Bertelson NL, Kalkbrenner KA, MercheaA, Dozois EJ, Landmann RG, De Petris G, et al. Dis Colon Rectum 2012;55(11);1111-6. [CrossRef] google scholar
  • 28. Buskermolen M, Naber SK, Toes-Zoutendijk E, van der Meulen MP, van Grevenstein WMU, van Leerdam ME, et al. Impact of surgical versus endoscopic management of complex nonmalignant polyps in a colorectal cancer screening program. Endoscopy 2022;54(9):871-80. [CrossRef] google scholar
There are 28 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section RESEARCH
Authors

Burak İlhan 0000-0002-7538-7399

Enver Kunduz 0000-0002-7686-2809

Özge Pasin 0000-0002-7837-9861

Derya Uymaz 0000-0002-2590-5872

Emre Balık 0000-0001-5751-1133

Publication Date March 30, 2023
Submission Date May 26, 2022
Published in Issue Year 2023 Volume: 86 Issue: 2

Cite

APA İlhan, B., Kunduz, E., Pasin, Ö., Uymaz, D., et al. (2023). SURGICAL MANAGEMENT OF ENDOSCOPICALLY UNRESECTABLE COLORECTAL POLYPS. Journal of Istanbul Faculty of Medicine, 86(2), 130-137. https://doi.org/10.26650/IUITFD.1115321
AMA İlhan B, Kunduz E, Pasin Ö, Uymaz D, Balık E. SURGICAL MANAGEMENT OF ENDOSCOPICALLY UNRESECTABLE COLORECTAL POLYPS. İst Tıp Fak Derg. March 2023;86(2):130-137. doi:10.26650/IUITFD.1115321
Chicago İlhan, Burak, Enver Kunduz, Özge Pasin, Derya Uymaz, and Emre Balık. “SURGICAL MANAGEMENT OF ENDOSCOPICALLY UNRESECTABLE COLORECTAL POLYPS”. Journal of Istanbul Faculty of Medicine 86, no. 2 (March 2023): 130-37. https://doi.org/10.26650/IUITFD.1115321.
EndNote İlhan B, Kunduz E, Pasin Ö, Uymaz D, Balık E (March 1, 2023) SURGICAL MANAGEMENT OF ENDOSCOPICALLY UNRESECTABLE COLORECTAL POLYPS. Journal of Istanbul Faculty of Medicine 86 2 130–137.
IEEE B. İlhan, E. Kunduz, Ö. Pasin, D. Uymaz, and E. Balık, “SURGICAL MANAGEMENT OF ENDOSCOPICALLY UNRESECTABLE COLORECTAL POLYPS”, İst Tıp Fak Derg, vol. 86, no. 2, pp. 130–137, 2023, doi: 10.26650/IUITFD.1115321.
ISNAD İlhan, Burak et al. “SURGICAL MANAGEMENT OF ENDOSCOPICALLY UNRESECTABLE COLORECTAL POLYPS”. Journal of Istanbul Faculty of Medicine 86/2 (March 2023), 130-137. https://doi.org/10.26650/IUITFD.1115321.
JAMA İlhan B, Kunduz E, Pasin Ö, Uymaz D, Balık E. SURGICAL MANAGEMENT OF ENDOSCOPICALLY UNRESECTABLE COLORECTAL POLYPS. İst Tıp Fak Derg. 2023;86:130–137.
MLA İlhan, Burak et al. “SURGICAL MANAGEMENT OF ENDOSCOPICALLY UNRESECTABLE COLORECTAL POLYPS”. Journal of Istanbul Faculty of Medicine, vol. 86, no. 2, 2023, pp. 130-7, doi:10.26650/IUITFD.1115321.
Vancouver İlhan B, Kunduz E, Pasin Ö, Uymaz D, Balık E. SURGICAL MANAGEMENT OF ENDOSCOPICALLY UNRESECTABLE COLORECTAL POLYPS. İst Tıp Fak Derg. 2023;86(2):130-7.

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