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Role of Endoscopic Resection Versus Surgical Resection in Management of Malignant Colon Polyps: a National Cancer Database Analysis

  • 2019 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Endoscopic resection (polypectomy) or surgery, are the main approaches in management of malignant colon polyps. There are very few large population-based studies comparing outcomes between the two.

Methods

Using the National Cancer Database, we identified patients ≥ 18 years with the first diagnosis of T1N0M0 malignant polyp from 2004 to 2015. Patients with a positive resection margin were excluded. Outcomes were compared between those who had surgery versus those who had polypectomy. Overall survival was compared using Kaplan-Meier curves. Multivariate Cox proportional hazards analysis was performed to generate hazard ratios, adjusted for patient, demographic, and tumor factors.

Results

A total of 31,062 patients met the inclusion criteria, out of which 2593 (8.3%) underwent polypectomy alone and 28,469 (91.7%) had surgery. Overall survival was significantly better in the surgical group compared with the polypectomy group. One-year and 5-year survival for surgery were 95.8% and 86.1% respectively compared with 94.2% and 80.6% for polypectomy (p < .0001). Hazard ratio for surgery after adjusting for various clinical-, demographic-, and tumor-level factors was 0.53 (p < .0001).

Conclusion

Our study is the largest population-based analysis of patients with T1N0M0 malignant colon polyps. Overall survival was higher in patients who underwent surgery compared with polypectomy. This remained consistent even after adjusting for multiple patient and tumor factors between the two groups.

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Acknowledgments

Dhruv Lowe and Shreya Sinha designed the study, performed the literature review, and wrote the manuscript.

Gary Brooks performed the statistical analysis, generated the figures, and edited the manuscript.

Sheikh Saleem and Muhammad Arif edited the manuscript.

Grant Support and Other Assistance

Funding for this project was provided by the Division of Gastroenterology and Hepatology, Department of Medicine, State University of New York, Upstate Medical University.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, NY, 13202, USA

    Dhruv Lowe, Sheikh Saleem & Muhammad Osman Arif

  2. Division of Hematology and Oncology, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, NY, 13202, USA

    Shreya Sinha

  3. Department of Public Health and Preventive Medicine, Center for Research and Evaluation, SUNY Upstate Medical University, Syracuse, NY, 13210, USA

    Gary Brooks

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  1. Dhruv Lowe
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Correspondence to Dhruv Lowe.

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Lowe, D., Saleem, S., Arif, M.O. et al. Role of Endoscopic Resection Versus Surgical Resection in Management of Malignant Colon Polyps: a National Cancer Database Analysis. J Gastrointest Surg 24, 177–187 (2020). https://doi.org/10.1007/s11605-019-04356-0

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  • DOI: https://doi.org/10.1007/s11605-019-04356-0

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