Skip to main content
SpringerLink
Log in

Management of the colonic polyps referred for surgery: an opportunity for improvement

  • 2021 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Purpose

To examine local practice for non-malignant polyps and to calculate morbidity and mortality associated with bowel resection for this indication.

Methods

This retrospective cohort study was conducted by reviewing our local gastrointestinal pathology database over a five-year period to identify colonic resections performed for benign polyps. Using search terms “polyp” and “adenoma,” 272 cases were identified. Exclusion criteria included: cancer diagnosis, emergency surgeries, multiple resections, and subtotal colectomies for polyposis. 106 patients were included in the study. Primary outcome was perioperative mortality. Secondary outcomes included patient morbidity, characteristics of polyps requiring surgery, and the number of patients referred for a second endoscopic opinion prior to proceeding with surgery.

Results

64 male and 42 female patients with a mean age of 65.3 years (± 8.6 years) underwent colon resection for benign polyps. The mean polyp size was 32.7 mm (± 19.5 mm). 30 patients (28.6%) had polyps equal to or less than 2 cm. Most of the polyps described were sessile (n = 55, 51.9%) and located in the right colon (n = 84, 79.3%). Endoscopic resection was attempted in 31 patients (29.2%), and five cases (4.7%) were referred for a second endoscopic opinion prior to proceeding with surgery. Endoscopists incorrectly felt that polyps were malignant in 62 cases (58.5%). Using Clavien-Dindo classification, most patients had no complications n = 36 (34.0%) or minor complications n = 41 (38.7%). Twelve patients (11.3%) had complications that required antibiotics, blood transfusions, or total parental nutrition. Nine patients (8.5%) required surgical or endoscopic management. Six patients (5.7%) required ICU admission. Mortality rate was 1.9% (n = 2).

Conclusion

Surgery for benign colonic polyps is associated with significant morbidity and mortality. These findings reveal a gap in endoscopic management of benign colonic polyps.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart RW, Hellinger M, Flanagan R, Peters W, Nelson H (2007) Laparoscopic Colectomy for Cancer Is Not Inferior to Open Surgery Based on 5-Year Data From the COST Study Group Trial. Ann Surg. https://doi.org/10.1097/SLA.0b013e318155a762

    Article  PubMed  Google Scholar 

  2. Winawer SJ, Zauber AG, Ho MN et al (1993) Prevention of colorectal cancer by colonoscopic polypectomy. N Engl J Med 329(27):1977–1981

    Article  CAS  Google Scholar 

  3. Peery AF, Shaheen NJ, Cools KS, Baron TH, Koruda M, Galanko JA et al (2018) Morbidity and mortality after surgery for nonmalignant colorectal polyps. Gastrointest Endosc. https://doi.org/10.1016/j.gie.2017.03.1550

    Article  PubMed  Google Scholar 

  4. Rao AK, Soetikno R, Raju GS, Lum P, Rouse RV, Sato T, Titzer-Schwarzl D, Aisenberg J, Kaltenbach T (2016) Large sessile serrated polyps can be safely and effectively removed by endoscopic mucosal resection. Clin Gastroenterol Hepatol. https://doi.org/10.1016/j.cgh.2015.10.013

    Article  PubMed  Google Scholar 

  5. Keswani RN, Law R, Ciolino JD, Lo AA, Gluskin AB, Bentrem DJ, Komanduri S, Pacheco JA, Grande D, Thompson WK (2016) Adverse events after surgery for nonmalignant colon polyps are common and associated with increased length of stay and costs. Gastrointest Endosc. https://doi.org/10.1016/j.gie.2016.01.048

    Article  PubMed  Google Scholar 

  6. Law R, Das A, Gregory D, Komanduri S, Muthusamy R, Rastogi A, Vargo J, Wallace MB, Raju GS, Mounzer R, Klapman J, Shah J, Watson R, Wilson R, Edmundoqicz SA, Wani S (2016) Endoscopic resection is cost-effective compared with laparoscopic resection in the management of complex colon polyps: an economic analysis. Gastrointest Endosc. https://doi.org/10.1016/j.gie.2015.11.014

    Article  PubMed  Google Scholar 

  7. Tholoor S, Tsagkournis O, Basford P, Bhandari P (2013) Managing difficult polyps: techniques and pitfalls. Ann Gastroenterol. https://doi.org/10.1053/j.gastro.2018.01.003,April

    Article  PubMed  PubMed Central  Google Scholar 

  8. Peery AF, Cools KS, Strassle PD, McGill SK, Crockett SD, Barker A, Koruda M, Grimm IS (2018) Increasing rates of surgery for patients with nonmalignant colorectal polyps in the United States. Gastroenterol. https://doi.org/10.1053/j.gastro.2018.01.003

    Article  Google Scholar 

  9. Zogg CK, Najjar P, Diaz AJR, Zogg DL, Tsai TC, Rose JA, Scott JW, Gani F, Alshaikh H, Canner JK, Schneider EB, Goldberg JE (2016) Haider AH (2016). Rethinking Priorities. https://doi.org/10.1097/SLA.0000000000001511

    Article  Google Scholar 

  10. Ma C, Teriaky A, Sheh S, Forbes N, Heitman SJ, Jue TL, Munroe CA, Jairath V, Corley DA, Lee JK (2019) Morbidity and mortality after surgery for nonmalignant colorectal polyps a 10-year nationwide analysis. Am J Gastroenterol. https://doi.org/10.14309/ajg.0000000000000407

    Article  PubMed  PubMed Central  Google Scholar 

  11. Hassan C, Repici A, Sharma P, Correale L, Zullo A, Bretthauer M, Senore C, Spada C, Bellisario C, Bhandari P, Rex DK (2016) Efficacy and safety of endoscopic resection of large colorectal polyps: a systematic review and meta-analysis. Gut. https://doi.org/10.1136/gutjnl-2014-308481

    Article  PubMed  Google Scholar 

  12. Doyle DJ, Goyal AG, Bansal P (2021). American Society of Anesthesiologists Classification. StatPearls [Internet]. Available at: https://pubmed.ncbi.nlm.nih.gov/28722969/. , 2021.

  13. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibanes E, Pekoji J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. https://doi.org/10.1097/SLA.0b013e3181b13ca2

    Article  PubMed  Google Scholar 

  14. Mitchell RA, Zhang C, Galorport C, Walker B, Telford J, Enns R (2018) Characteristics of patients with colonic polyps requiring segmental resection. Canadian J Gastroenterol Hepatol. https://doi.org/10.1155/2018/7046385

    Article  Google Scholar 

  15. Draganov PV, Wang AY, Othman MO, Fukami N (2018) AGA institute clinical practice update: endoscopic submucosal dissection in the United States. Clin Gastroenterol Hepatol. https://doi.org/10.1016/j.cgh.2018.07.041

    Article  PubMed  Google Scholar 

  16. Vosko S, Shahidi N, Sidhu M, Arnout van Hattem W, Bar-Yishay I, Schoeman S, Tate DJ, Hourigan LF, Singh R, Moss A, Byth K, Lee EYT, Burgess NG, Bourke M (2021) Optical evaluation for predicting cancer in large nonpedunculated colorectal polyps is accurate for flat lesions. Clin Gastroenterol Hepatol. https://doi.org/10.1016/j.cgh.2021.05.017

    Article  PubMed  Google Scholar 

  17. van Doorn S, Hazewinkel Y, East J, van Leerdam M, Rastogi A, Pellise M, Sanduleanu-Dascallescu S, Bastiaansen BAJ, Fockens P, Evelien D (2015) Polyp morphology: an interobserver evaluation for the paris classification among international experts. Am J Gastroenterol. https://doi.org/10.1038/ajg.2014.326

    Article  PubMed  Google Scholar 

  18. Kudo S, Tamura S, Nakajima T, Yamano H, Kusaka H, Watanabe H (1996) Diagnosis of colorectal tumorous lesions by magnifying endoscopy. Gastrointest Endosc. https://doi.org/10.1016/s0016-5107(96)70222-5

    Article  PubMed  Google Scholar 

  19. Raju G, Lum P, Ross W, Thirumurthi S, Miller E, Lynch P, Lee J, Bhutani MS, Shafi MA, Weston B, Blechacz B, Chang GJ, Hagan K, Rashid A, Davila M, Stroehlein J (2019) Quality of endoscopy reporting at index colonoscopy significantly impacts outcome of subsequent EMR in patients with> 20 mm colon polyps. Endoscopy international open. https://doi.org/10.1055/a-0746-3520

    Article  PubMed  PubMed Central  Google Scholar 

  20. Longcroft-Wheaton G, Duku M, Mead R, Basford P, Bhandari P (2013) Risk stratification system for evaluation of complex polyps can predict outcomes of endoscopic mucosal resection. Dis Colon Rectum. https://doi.org/10.1097/DCR.0b013e31829193e0

    Article  PubMed  Google Scholar 

  21. Jayanna M, Burgess NG, Singh R, Hourigan LF, Brown GJ, Zanati SA, Moss A, Lim J, Sonson R, Williams SJ, Bourke MJ (2016) Cost analysis of endoscopic mucosal resection vs surgery for large laterally spreading colorectal lesions. Clin Gastroenterol Hepatol. https://doi.org/10.1016/j.cgh.2015.08.037

    Article  PubMed  Google Scholar 

  22. Morales TG, Sampliner RE, Garewal HS, Fennerty MB, Aickin M (1996) The difference in colon polyp size before and after removal. Gastrointest Endosc. https://doi.org/10.1016/s0016-5107(96)70255-9

    Article  PubMed  Google Scholar 

Download references

Funding

There was no funding involved in this project.

Author information

Authors and Affiliations

  1. Department of Surgery, Memorial University of Newfoundland, St. John’s, NL, Canada

    Cecily Stockley, Bradley Evans, Muna Lougheed & David Pace

  2. Department of Family Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada

    Haley Flemming

  3. Department of Pathology, Memorial University of Newfoundland, St. John’s, NL, Canada

    Altaf Taher

  4. Department of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada

    Mark Borgaonkar

Authors
  1. Cecily Stockley
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bradley Evans
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Muna Lougheed
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Haley Flemming
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Altaf Taher
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mark Borgaonkar
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. David Pace
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cecily Stockley.

Ethics declarations

Disclosures

Drs. Stockley, Evans, Lougheed, Flemming, Borgaonkar, Taher and Pace have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Stockley, C., Evans, B., Lougheed, M. et al. Management of the colonic polyps referred for surgery: an opportunity for improvement. Surg Endosc 36, 5392–5397 (2022). https://doi.org/10.1007/s00464-021-08858-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-021-08858-4

Keywords

Search

Navigation