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Colon Polyps and the Prevention of Colorectal Cancer pp 153–161Cite as

Surgical Management of Colon Polyps

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Abstract

The first goal of polyp treatment is the endoscopic resection of the polyp during colonoscopy. Various methods (e.g., cold biopsy, hot biopsy, snare, and hot snaring) are applied based on the size and location of the polyp. Four techniques were defined for removing small polyps. If the polyp is smaller than 3 mm and is located especially at the right colon, it can be resected by forceps polypectomy (cold biopsy). Entire lesion should be within the jaws of the biopsy forceps and, when possible, lesion should be removed all together by a single bite. If residual polyp tissue is observed, a second procedure might be required. Jumbo forceps can be useful for resecting the polyp completely at the first trial. The advantage of this technique is its low risk. Hot biopsy procedure is similar to the cold biopsy. Here, after the polyp is engulfed and pulled slightly, diathermy is applied with a catheter in order to ablate its stem. It is suitable for polyps larger than 5 mm. The disadvantages of this technique are postpolypectomy bleeding and risk of perforation. The latter is the result of excessive diathermy. Accordingly, especially when whitening is observed on the polyp stem, diathermy should be ceased. Many colonoscopists gave up the hot biopsy technique due to its inconvenience. Cold snaring is preferred for sessile polyps smaller than 7 mm. On the other hand, it is difficult to resect the lesions bigger than 7 mm using cold snare without diathermy and has an increased bleeding risk. Polyps bigger than 7–8 mm in size require diathermy with snare (hot snaring). It is indicated for cases unsuitable for polypectomy, when the polyp cannot be removed completely. There are two fundamental indicators of polyp surgery: (1) Sessile or pedunculated polyps that cannot be removed endoscopically (difficult polyps, see (Table 10.1)), (2) polyps with a risk of malignity, especially those with invasive carcinoma.

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References

  1. Kapsoritakis AN, Potamianos SP, Koukourakis MI, et al. Diminutive polyps of large bowel should be an early target for endoscopic treatment. Dig Liver Dis. 2002;34:137–40.

    Article  CAS  PubMed  Google Scholar 

  2. Rex DK. Management of small and diminutive polyps. Tech Gastrointest Endosc. 2013;15:77–81.

    Article  Google Scholar 

  3. Draganov PV, Chang MN, Alkhasawneh A, Dixon LR, Lieb J, Moshiree B, et al. Randomized, controlledtrial of standard, large-capacity versus jumbo biopsy forceps for polypectomy of small, sessile, colorectal polyps. Gastrointest Endosc. 2012;75:118–26.

    Article  PubMed  Google Scholar 

  4. Ellis K, Shiel M, Marquis S, Katon R. Efficacy of hot biopsyforeceps, coldmicro-snare and microsnare with cautery techniques in the removal of diminutive colonic polyps. Gastrointest Endosc. 1997;45:AB107.

    Article  Google Scholar 

  5. Vormbrock K, Mönkemüller K. Difficult colon polypectomy. World J Gastrointest Endosc. 2012;4(7):269–80.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Moss A, BourkeM J, Williams SJ, et al. Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia. Gastroenterology. 2011;140:1909–18.

    Article  PubMed  Google Scholar 

  7. Agrawal D, Chak A, Champagne BJ, et al. Endoscopic mucosal resection with full-thickness closure for difficult polyps: a prospective clinical trial. Gastrointest Endosc. 2010;71(6):1082–8.

    Article  PubMed  Google Scholar 

  8. Horgan G, East JE, Saunders BP. Malignant polyp. Tech Gastrointest Endosc. 2013;15:106–12.

    Article  Google Scholar 

  9. Workshop P. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 toDecember 1, 2002. Gastrointest Endosc. 2003;58:S3–43.

    Article  Google Scholar 

  10. Kudo S. Endoscopic mucosal resection of flat and depressed types of early colorectal cancer. Endoscopy. 1993;25:455–61.

    Article  CAS  PubMed  Google Scholar 

  11. Cipolletta L, Bianco MA, Rotondano G, Catalano M, Prisco A, De Simone T. Endoclip-assisted resection of large pedunculated colon polyps. Gastrointest Endosc. 1999;50(3):405–7.

    Article  CAS  PubMed  Google Scholar 

  12. Lee MK, Chen F, Esrailian E, et al. Combined endoscopic and laparoscopic surgery may be an alternative to bowel resection for the management of colon polyps not removable by standard colonoscopy. Surg Endosc. 2013;27(6):2082–6.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Bronner MP, Taylor SL, Bennett AE. Serrated sesil polyp. 1327 biopsy pathology of common and problematic lesions of the gastrointestinal tract. ASCP Workshop Book 2010:61–65.

    Google Scholar 

  14. Winawer SJ, Zauber AG, Fletcher RH, Stillman JS, et al. Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. CA Cancer J Clin. 2006;56(3):143–59; quiz 184–5.

    Article  PubMed  Google Scholar 

  15. Cubiella J, Castro I, Hernandez V, González-Mao C, et al.; COLON PREV study investigators. Characteristics of adenomas detected by fecal immunochemical test in colorectal cancer screening. Cancer Epidemiol Biomarkers Prev. 2014;23(9):1884–92. doi: 10.1158/1055-9965.EPI-13-1346. Epub 2014 Jun 24.

  16. Levin B, Lieberman DA, McFarland B, Andrews KS, et al.; American Cancer Society Colorectal Cancer AdvisoryGroup; US Multi-Society Task Force; American College of Radiology Colon Cancer Committee. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology. 2008;134(5):1570–95. doi: 10.1053/j.gastro.2008.02.002. Epub 2008 Feb 8.

  17. Tony J, Harish K, Ramachandran TM, Sunilkumar K, Thomas V. Profile of colonic polyps in a southern Indian population. Indian J Gastroenterol. 2007;26(3):127–9.

    PubMed  Google Scholar 

  18. O’Brien MJ, Winawer SJ, Zauber AG, et al. The National Polyp Study: patient and polyp characteristic sassociated with high-grade dysplasia in colorectal adenomas. Gastroenterology. 1990;98:371–9.

    PubMed  Google Scholar 

  19. Kil Lee S, Il Kim T, KwanShin S, Ho Kim W, Kim H, Kyu Kim N. Comparison of the clinicopathologic features between flat and polypoid adenoma. Scand J Gastroenterol. 2008;43(9):1116–21.

    Article  PubMed  Google Scholar 

  20. Steigen SE, Isaksen V, Skjæveland A, Vonen B. Adenomas with adenocarcinoma: a study evaluating the risk of residual cancer and lymph node metastasis. Scand J Surg. 2013;102(2):90–5.

    Article  CAS  PubMed  Google Scholar 

  21. Haggitt RC, Glotzbach RE, Soffer EE, Wruble LD. Prognostic factors in colorectal carcinomas arising in adenomas: implications for lesions removed by endoscopic polypectomy. Gastroenterology. 1985;89(2):328–36.

    CAS  PubMed  Google Scholar 

  22. Bujanda L, Cosme A, Gil I, Arenas-Mirave JI. Malignant colorectal polyps. World J Gastroenterol. 2010;16(25):3103–11.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Schlemper RJ, Riddell RH, Kato Y, Borchard F, et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut. 2000;47(2):251–5.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Kitajima K, Fujimori T, Fujii S, Takeda J, et al. Correlations between lymph node metastasis and depth of submucosal invasion in submucosal invasive colorectal carcinoma: a Japanese collaborative study. J Gastroenterol. 2004;39(6):534–43.

    PubMed  Google Scholar 

  25. Tytherleigh MG, Warren BF, Mortensen NJ. Management of early rectal cancer. Br J Surg. 2008;95(4):409–23. doi:10.1002/bjs.6127.

    Article  CAS  PubMed  Google Scholar 

  26. Pollard CW, Nivatvongs S, Rojanasakul A, Reiman HM, Dozois RR. The fate of patients following polypectomy alone for polyps containing invasive carcinoma. Dis Colon Rectum. 1992;35(10):933–7.

    Article  CAS  PubMed  Google Scholar 

  27. Netzer P, Forster C, Biral R, Ruchti C, Neuweiler J, Stauffer E, Schönegg R, Maurer C, Hüsler J, Halter F, Schmassmann A. Risk factor assessment of endoscopically removed malignant colorectal polyps. Gut. 1998;43(5):669–74.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  28. Robert ME. The malignant colon polyp: diagnosis and therapeutic recommendations. Clin Gastroenterol Hepatol. 2007;5(6):662–7.

    Article  PubMed  Google Scholar 

  29. Plawski A, Banasiewicz T, Borun P, Kubaszewski L, Krokowicz P, Skrzypczak-Zielinska M, Lubinski J. Familial adenomatous polyposis of the colon. Hered Cancer Clin Pract. 2013;11(1):15. doi:10.1186/1897-4287-11-15.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Ibrahim A, Barnes DR, Dunlop J, Barrowdale D, Antoniou AC, Berg JN. Attenuated familial adenomatous polyposis manifests as autosomal dominant late-onset colorectal cancer. Eur J Hum Genet. 2014;22:1330–3.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  31. Cruz RA, Ragupathi M, Pedraza R, Pickron TB, et al. Minimally invasive approach for the management of “difficult” colonic polyps. Diagn Ther Endosc. 2011;2011:Article ID 682793, 5 pages.

    Google Scholar 

  32. Hahnloser D. Combined endoscopic laparoscopic resection of colonic polyps. Dig Dis. 2012;30 suppl 2:81–4.

    Article  PubMed  Google Scholar 

  33. Kaleem AZ, Strachan C, Whittaker L, Ahmad SM. Colonoscopicaly assisted laparoscopic polypectomy_an alternative to right hemicolectomy for large right sided benign polyps. Surg Sci. 2013;4:350–3.

    Article  Google Scholar 

  34. Itah R, Greenberg R, Nir S, Karin E, Skornick Y, Avital S. Laparoscopic surgery for colorectal polyps. JSLS. 2009;13:555–9.

    Article  PubMed Central  PubMed  Google Scholar 

  35. O’Leary DP, Fide CJ, Foy C, Lucarotti ME. Quality of life after low anterior resection with total mesorectal excision and temporary loop ileostomy for rectal carcinoma. Br J Surg. 2002;88(9):1216–20.

    Article  Google Scholar 

  36. Karahasanoglu T, Hamzaoglu I, Baca B, Aytac E, et al. Evaluation of diverting ileostomy in laparoscopic low anterior resection for rectal cancer. Asian J Surg. 2011;34(2):63–8.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Surgery Department, Gaziosmanpasa Taksim Teaching and Training Hospital, Istanbul, Turkey

    Okan Demiray MD & Dogan Gonullu MD

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  1. Okan Demiray MD
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  2. Dogan Gonullu MD
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Correspondence to Okan Demiray MD .

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Editors and Affiliations

  1. Department of Surgery, Izmir Buca Hospital, Buca, Izmir, Turkey

    Omer Engin

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Demiray, O., Gonullu, D. (2015). Surgical Management of Colon Polyps. In: Engin, O. (eds) Colon Polyps and the Prevention of Colorectal Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-17993-3_10

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  • DOI: https://doi.org/10.1007/978-3-319-17993-3_10

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-17992-6

  • Online ISBN: 978-3-319-17993-3

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