Journal of Gastrointestinal Surgery

, Volume 16, Issue 1, pp 165–172

Oncologic Colorectal Resection, Not Advanced Endoscopic Polypectomy, Is the Best Treatment for Large Dysplastic Adenomas

  • Joon Ho Jang
  • Emre Balik
  • Daniel Kirchoff
  • Wouter Tromp
  • Anjali Kumar
  • Michael Grieco
  • Daniel L. Feingold
  • Vesna Cekic
  • Linda Njoh
  • Richard L. Whelan
2011 SSAT Plenary Presentation

DOI: 10.1007/s11605-011-1746-9

Cite this article as:
Jang, J.H., Balik, E., Kirchoff, D. et al. J Gastrointest Surg (2012) 16: 165. doi:10.1007/s11605-011-1746-9

Abstract

Introduction

Endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), and partial circumference resection are used for large benign polyps to avoid an “Oncologic” Colorectal Resection (OCR); polyps with invasive cancer require OCR. This review of polyp patients who had OCR was done to stratify polyps into risk groups to guide treatment.

Methods

Colonoscopy, operative, and pathology reports of patients with adenoma (+/− dysplasia) who had OCR were reviewed. Polyp size, location, and pathology were assessed.

Results

Three hundred eighty-six polyp patients who had OCR were studied. Polyp locations were: right, 263 (68.1%); transverse, 33 (8.6%); sigmoid, 38 (9.8%); rectum, 23 (6.0%); and multiple sites, 13 (3.4%). The preoperative diagnosis was adenoma for 288 (74.6%) and dysplastic adenoma for 98 patients (25.4%). Final pathology revealed 62 invasive cancers (16.1%); 35% (34 out of 98) with dysplasia preoperatively had cancer versus 9.7% (28 out of 288) with adenoma alone (p < 0.0001). The mean lymph node count was 16.0 ± 10.2. Cancer stage breakdown was: stage 1, 74%; stage 2, 8.1%; stage 3, 16%; and stage 4, 1.6%. The mean benign polyp size was 3.0 ± 1.9 versus 3.9 ± 2.4 cm for malignant polyps (p = 0.0008).

Conclusion

Over one out of three of dysplastic polyps and 10% of adenomas were invasive cancers. OCR is advised for dysplastic polyps; ESD, EMR, and wedge resection are appropriate for non-dysplastic adenomas.

Keywords

Colorectal cancer Adenoma Dysplasia Oncologic colorectal resection 

Copyright information

© The Society for Surgery of the Alimentary Tract 2011

Authors and Affiliations

  • Joon Ho Jang
    • 1
  • Emre Balik
    • 2
  • Daniel Kirchoff
    • 1
  • Wouter Tromp
    • 1
  • Anjali Kumar
    • 4
  • Michael Grieco
    • 1
  • Daniel L. Feingold
    • 3
  • Vesna Cekic
    • 1
  • Linda Njoh
    • 1
  • Richard L. Whelan
    • 5
  1. 1.Section of Colon and Rectal Surgery, Department of SurgerySt. Luke’s Roosevelt Hospital CenterNew YorkUSA
  2. 2.Istanbul University Associate Professor of Surgery Section of Colon and Rectal SurgeryDepartment of SurgeryIstanbulTurkey
  3. 3.Columbia University Medical Center, Section of Colon and Rectal SurgeryDepartment of SurgeryNew YorkUSA
  4. 4.Section of Colon and Rectal SurgeryDepartment of Surgery, Washington Hospital CenterWashingtonUSA
  5. 5.Section of Colon and Rectal Surgery, Department of SurgerySt. Luke’s Roosevelt Hospital CenterNew YorkUSA

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