World Journal of Surgery

, Volume 15, Issue 1, pp 35–40 | Cite as

Treatment of carcinoma in adenomas

  • Tetsuichiro Muto
  • Toshio Sawada
  • Kenichi Sugihara
Progress Symposium—Colorectal Polyps

Abstract

Invasive carcinomas in polyps removed during endoscopy are described. Most of them can be treated adequately by polypectomy alone, but some need additional surgical treatment. Incomplete excision, poorly-differentiated carcinoma, and lymphatic invasion are associated with increased risk of residual carcinoma and lymph node metastases, making colorectal resection more attractive; however, in elderly patients and poor-risk patients, the risks of surgery should be balanced against the possible advantage of curative surgery. Rectal polyps may be large but sphincter preservation can usually be achieved by different types of local excision. Recently described flat adenomas may contain carcinoma, but may also be treated by polypectomy using snare or hot biopsy.

Résumé

On décrit le cancer invasif dans les polypes enlevés par endoscopie. La plupart d'entre eux sont bien traités par la polypectomie seule mais certains ont besoin ensuite d'un traitement chirurgical. Une excision incomplète, un carcinome peu différencié, et une invasion lymphatique sont facteurs de risque de cancer résiduel et de métastases lymphatiques, rendant plus logique la résection intestinale correspondante. Toutefois, chez les patients âgés et à haut risque, on doit peser les dangers et avantages éventuels d'une chirurgie curative. MÊme si les polypes rectaux sont gros, la conservation du sphincter s'effectue en général grâce à différents types d'excisisons locales. Les adénomes plats décrits récemment peuvent Être cancéreux mais peuvent aussi Être traités par la polypectomie à l'anse diathermique ou par la biopsie chirurgicale.

Resumen

Se describen los carcinomas presentes en pólipos resecados por endoscopia. La mayoría de éstos puede ser tratada en forma adecuada mediante polipectomía solamente, pero algunos requieren terapia adicional. La resección incompleta, el carcinoma pobremente diferenciado, y la invasión linfática aparecen asociados con mayor riesgo de carcinoma residual y de metástasis ganglionares, lo cual hace más atractiva la resección colorrectal. Sin embargo, en los ancianos y en pacientes de alto riesgo quirÚrgico, el riesgo de la operación debe ser balanceado contra la posible ventaja de la cirugía realizada con propósito curativo. Los pólipos rectales pueden ser de gran tamaño, pero generalmente se puede lograr la preservación esfinteriana mediante diferentes tipos de resección local. Los recientemente descritos adenomas planos pueden contener carcinoma, pero éstos también son susceptibles de tratamiento por polipectomía mediante el asa de electrocauterio o la biopsia caliente.

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Copyright information

© Société Internationale de Chirurgie 1991

Authors and Affiliations

  • Tetsuichiro Muto
    • 1
  • Toshio Sawada
    • 1
  • Kenichi Sugihara
    • 1
  1. 1.Department of SurgeryUniversity of TokyoTokyoJapan

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