Advertisement

The management of malignant polyps in colorectal cancer screening programmes: A retrospective Italian multi-centre study

      Abstract

      Background

      Although recognition of colorectal malignant polyps is increasing, treatment plans lack the evidence of randomised trials.

      Aim

      To retrospectively evaluate presentation, management and outcomes of screen-detected colorectal malignant polyps, with special focus on the role of histological factors in therapeutic decision-making.

      Methods

      We retrospectively analysed data regarding malignant polyps detected during faecal immuno-chemical test-based screening programmes in five centres in North-Eastern Italy between April 2008 and April 2013.

      Results

      306 malignant polyps in 306 patients were included; 72 patients underwent surgery directly (23.6%). Of 234 patients treated endoscopically, 133 subsequently underwent radicalisation surgery (56.8%) and in 17 there was evidence of residual disease (12.8%). Involved, unsafe (<1 mm) or invaluable resection margins and sessile morphology represented the most frequent determinants of subsequent surgery. The mean number of nodes harvested during radicalisation surgery was 7.1 ± 6.4 (range 0–29). Histological diagnosis was re-evaluated according to new guidelines in 125 cases (41%); in 18 this led to modification of the risk class (14.4%).

      Conclusions

      Although the rate of surgical treatment following endoscopic resection is similar to other studies, residual disease at surgery was lower than most international series. Adhering to the new histological reporting system and respecting guidelines on node harvesting may favourably influence prognosis.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Digestive and Liver Disease
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bond J.H.
        Polyp guideline: diagnosis, treatment and surveillance for patients with colorectal polyps. Practice Parameters Committee of the American College of Gastroenterology.
        American Journal of Gastroenterology. 2000; 95: 3053-3063
        • Muto T.
        • Sawada T.
        • Sugihara K.
        Treatment of carcinoma in adenomas.
        World Journal of Surgery. 1991; 15: 35-40
        • Ramirez M.
        • Schiering S.
        • Papaconstantinou H.T.
        • et al.
        Management of the malignant polyp.
        Clinics in Colon and Rectal Surgery. 2008; 21: 286-290
        • Quirke P.
        • Risio M.
        • Lambert R.
        • et al.
        European guidelines for quality assurance in colorectal cancer screening and diagnosis. First Edition – quality assurance in pathology in colorectal cancer screening and diagnosis.
        Endoscopy. 2012; 44: SE116-SE130
      1. National Code on Clinical Researches published in Official Gazette numbered with 28030 at April 13, 2013.

        • Cooper G.S.
        • Xu F.
        • Barnholtz Sloan J.S.
        • et al.
        Management of malignant colonic polyps: a population-based analysis of colonoscopic polypectomy versus surgery.
        Cancer. 2012; 118: 651-659
        • Gill M.D.
        • Rutter M.D.
        • Holtham S.J.
        Management and short term outcome of malignant colorectal polyps in the north of England.
        Colorectal Disease. 2013; 15: 169-176
        • Williams J.G.
        • Pullan R.D.
        • Hill J.
        • et al.
        Management of the malignant colorectal polyp: ACPGBI position statement.
        Colorectal Disease. 2013; 15: 1-38
        • Wasif N.
        • Etzioni D.
        • Maggard M.A.
        • et al.
        Trends, patterns, and outcomes in the management of malignant colonic polyps in the general population of the United States.
        Cancer. 2011; 117: 931-937
        • Hassan C.
        • Zullo A.
        • Risio M.
        • et al.
        Histologic risk factors and clinical outcome in colorectal malignant polyp: a pooled-data analysis.
        Diseases of the Colon & Rectum. 2005; 48: 1588-1596
        • Riley S.A.
        Colonscopic polypectomy and endoscopic mucosal resection: a practical guide.
        2008 (http://bsg.org.uk/pdf_word_docs/polypectomy_08.pdf)
        • Beaton C.
        • Twine C.P.
        • Williams G.L.
        • et al.
        Systematic review and meta-analysis of histopathological factors influencing the risk of lymph node metastases in early colorectal cancer.
        Colorectal Disease. 2013; 15: 788-797
        • Bosch S.L.
        • Teerenstra S.
        • de Wilt J.H.
        • et al.
        Predicting lymph node metastasis in pT1 colorectal cancer: a systematic review of risk factors providing rationale for therapy decisions.
        Endoscopy. 2013; 45: 827-834
        • Ueno K.
        • Mochizuki H.
        • Hashiguchi Y.
        • et al.
        Risk factors for an adverse outcome in early invasive colorectal carcinoma.
        Gastroenterology. 2004; 127: 385-394
        • Kim K.M.
        • Eo S.J.
        • Shim S.G.
        • et al.
        Risk factors for residual cancer and lymph node metastasis after noncurative endoscopic resection of early colorectal cancer.
        Diseases of the Colon and Rectum. 2013; 56: 35-42
        • Volk E.E.
        • Goldblum J.R.
        • Petras R.E.
        • et al.
        Management and outcome of patients with invasive carcinoma arising in colorectal polyps.
        Gastroenterology. 1995; 109: 1801-1807
        • Seitz U.
        • Bohnacker S.
        • Seewald S.
        • et al.
        Is endoscopic polypectomy an adequate therapy for malignant colorectal adenomas? Presentation of 114 patients and review of the literature.
        Diseases of the Colon and Rectum. 2004; 47: 1789-1796
        • Butte J.M.
        • Tang P.
        • Gonen M.
        • et al.
        Rate of residual disease after complete endoscopic resection of malignant colonic polyp.
        Diseases of the Colon and Rectum. 2012; 55: 122-127
        • Naqvi S.
        • Burroughs S.
        • Chave H.S.
        • et al.
        Management of colorectal polyp cancers.
        Annals of the Royal College of Surgeons of England. 2012; 94: 574-578
        • Benhaim L.
        • Benoist S.
        • Bachet J.B.
        • et al.
        Salvage colectomy for endoscopically removed malignant colon polyps: is it possible to determine the optimal number of lymph nodes that need to be harvested?.
        Colorectal Disease. 2012; 14: 79-88
        • Desch C.E.
        • McNiff K.K.
        • Schneider E.C.
        • et al.
        American Society of Clinical Oncology/National Comprehensive Cancer Network Quality Measures.
        Journal of Clinical Oncology. 2008; 26: 3631-3637
        • Freeman H.J.
        Long-term follow-up of patients with malignant pedunculated colon polyps after colonoscopic polypectomy.
        Canadian Journal of Gastroenterology. 2013; 27: 20-24
        • Bong-Hyeon Kye
        • Ji-Han Jung
        • Hyung-Jin Kim
        • et al.
        Tumor budding as a risk factor of lymph node metastasis in submucosal invasive T1 colorectal carcinoma: a retrospective study.
        BMC Surgery. 2012; 12: 16