Skip to main content

Advertisement

SpringerLink
Log in

Outcome of laparoscopic colectomy for polyps not suitable for endoscopic resection

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Large colonic polyps or polyps that lie in anatomical locations that are difficult to access at endoscopy may not be suitable for endoscopic resection and therefore may require partial colectomy. This approach eradicates the polyp and allows an oncologic resection should the polyp prove to be malignant. The purpose of this study was to assess outcomes of a laparoscopic approach for the management of these polyps.

Methods

Patients referred for laparoscopic colectomy for colonic polyps were identified from the prospective colorectal laparoscopic surgery database. Demographics, operative details, and final pathology were reviewed.

Results

Fifty-one consecutive patients (27 male) with a mean age of 68 ± 11.4 years, ASA classification (1/2/3/4) of 0/21/27/3, and body mass index (BMI) of 26.5 ± 4.9 were identified. Right (RHC) and left (LHC) colectomy was performed for 39 right and 12 left colonic polyps. Mean operating time (OT) was 87 ± 30 min (81 for RHC, 105 for LHC) and mean hospital stay was 3.1 ± 1.9 days. There were six complications (17.7%), including anastomotic leak (n = 1), small bowel obstruction (n = 2), abscess (n = 1), and exacerbation of preexisting medical conditions (n = 2). Four patients were readmitted (7.8%); one required CT scan-guided abscess drainage (1.9%) and two required reoperation (3.9%). Five patients (9.8%) were converted because of adhesions (n = 3), obesity (n = 1), and inability to identify the area that was tattooed at colonoscopy (n = 1). Mean polyp size was 3.1 cm, and pathology revealed tubular (n = 14), tubulovillous (n = 33) and villous adenoma (n = 2), pseudopolyp (n = 1), and prolapse of the appendix into the cecum mimicking an adenoma (n = 1). High-grade dysplasia was seen in four tubular (33%) and five tubulovillous adenomas (15.5%). Adenocarcinoma not identified at colonoscopy was found in 11 polyps (20%), 9 tubulovillous (27.8%) and both villous adenomas (100%).

Conclusions

Large colonic polyps unresectable at colonoscopy are associated with a high rate of unsuspected cancer. This requires a formal colectomy rather than transcolonic polypectomy. Laparoscopic colectomy offers safe and effective management of these polyps with the benefits of accelerated postoperative recovery.

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

Similar content being viewed by others

References

  1. Binmoeller KF, Bohnacker S, Seifert H, Thonke F, Valdeyar H, Soehendra N (1996) Endoscopic snare excision of “giant” colorectal polyps. Gastrointest Endosc 43: 183–188

    Article  PubMed  CAS  Google Scholar 

  2. Boulez J, Espalieu P, Fontaumard E, Meeus P (1997) Laparoscopic colo-rectal surgery: analysis of 113 cases. Hepatogastroenterology 44: 40–44

    PubMed  CAS  Google Scholar 

  3. Brooker JC, Saunders BP, Shah SG, Williams CB (2002) Endoscopic resection of large sessile colonic polyps by specialist and non-specialist endoscopists. Br J Surg 89: 1020–1024

    Article  PubMed  CAS  Google Scholar 

  4. Church JM (2003) Experience in the endoscopic management of large colonic polyps. ANZ J Surg 73: 988–995

    Article  PubMed  Google Scholar 

  5. Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350(20): 2050–2059

    Article  Google Scholar 

  6. Dean PA, Beart RW Jr, Nelson H, Elftmann TD, Schlinkert RT (1994) Laparoscopic-assisted segmental colectomy: early Mayo Clinic experience. Mayo Clin Proc 69: 834–840

    PubMed  CAS  Google Scholar 

  7. Delaney CP, Kiran RP, Senagore AJ, Brady K, Fazio VW (2003) Case-matched comparison of clinical and financial outcome after laparoscopic or open colorectal surgery. Ann Surg 238(1): 67–72

    Article  PubMed  Google Scholar 

  8. Doniec JM, Lohnert MS, Schniewind B, Bokelmann F, Kremer B, Grimm H (2003) Endoscopic removal of large colorectal polyps: prevention of unnecessary surgery? Dis Colon Rectum 46: 340–348

    Article  PubMed  Google Scholar 

  9. Duepree HJ, Senagore AJ, Delaney CP, Fazio VW (2003) Does means of access affect the incidence of small bowel obstruction and ventral hernia after bowel resection? Laparoscopy versus laparotomy. J Am Coll Surg. 197(2): 177–181

    Article  PubMed  Google Scholar 

  10. Eijsbouts QA, Heuff G, Sietses C, Meijer S, Cuesta MA (1999) Laparoscopic surgery in the treatment of colonic polyps. Br J Surg 86: 505–508

    Article  PubMed  CAS  Google Scholar 

  11. Franklin ME Jr, Diaz EJ, Abrego D, Parra-Davila E, Glass JL (2000) Laparoscopic-assisted colonoscopic polypectomy: the Texas Endosurgery Institute experience. Dis Colon Rectum 43: 1246–1249

    Article  PubMed  Google Scholar 

  12. Hensman C, Luck AJ, Hewett PJ (1999) Laparoscopic-assisted colonoscopic polypectomy: technique and preliminary experience. Surg Endosc 13: 231–232

    Article  PubMed  CAS  Google Scholar 

  13. Jacobs M, Verdeja JC, Goldstein HS (1991) Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1: 144–150

    PubMed  CAS  Google Scholar 

  14. Joo JS, Amarnath L, Wexner SD (1998) Is laparoscopic resection of colorectal polyps beneficial? Surg Endosc 12: 1341–1344

    Article  PubMed  CAS  Google Scholar 

  15. Kiran RP, Delaney CP, Senagore AJ, Millward BL, Fazio VW (2004) Operative blood loss and use of blood products after laparoscopic and conventional open colorectal operations. Arch Surg 139(1): 39–42

    Article  PubMed  Google Scholar 

  16. Lacy AM, Garcia-Valdecasas JC, Delgado S, Grande L, Fuster J, Tabet J, Ramas S, Pique JM, Cifuentes A, Visa J (1997) Postoperative complications of laparoscopic-assisted colectomy. Surg Endosc 11: 119–122

    Article  PubMed  CAS  Google Scholar 

  17. Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359(9325): 2224–2229

    Article  PubMed  Google Scholar 

  18. Le Picard P, Vacher B, Pouliquen X (1997) Laparoscopy-assisted colonic polypectomy or how to be helped by laparoscopy to prevent colectomy in benign colonic polyps considered to be unresectable by colonoscopy. Ann Chir 51(9): 986–989

    PubMed  CAS  Google Scholar 

  19. Leung KL, Kwok SP, Lam SC, Lee JF, Yiu RY, Ng SS, Lai PB, Lau WY (2004) Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet 363(9416): 1187–1192

    Article  PubMed  Google Scholar 

  20. Liang JT, Shieh MJ, Chen CN, Cheng YM, Chang KJ, Wang SM (2002) Prospective evaluation of laparoscopy-assisted colectomy versus laparotomy with resection for management of complex polyps of the sigmoid colon. World J Surg 26: 377–383

    Article  PubMed  Google Scholar 

  21. Mal F, Perniceni T, Levard H, Boudet MJ, Levy P, Gayet B (1998) Colonic polyps considered unresectable by endoscopy. Removal by combinations of laparoscopy and endoscopy in 65 patients. Gastroenterol Clin Biol 22(4): 425–430

    PubMed  CAS  Google Scholar 

  22. Nivatvongs S, Rojanasakul A, Reiman HM, Dozois RR, Woff BG, Pemberton JH, Beart RW Jr, Jacques LF (1991) The risk of lymph node metastasis in colorectal polyps with invasive adenocarcinoma. Dis Colon Rectum 34: 323–328

    Article  PubMed  CAS  Google Scholar 

  23. Phillips EH, Franklin M, Carroll BJ, Fallas MJ, Ramos R, Rosenthal D (1992) Laparoscopic colectomy. Ann Surg 216: 703–707

    Article  PubMed  CAS  Google Scholar 

  24. Prohm P, Weber J, Bonner C (2001) Laparoscopic-assisted coloscopic polypectomy. Dis Colon Rectum 44: 746–748

    Article  PubMed  CAS  Google Scholar 

  25. Schwenk W, Haase O, Neudecker J, Muller JM (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev (3): CD003145

  26. Senagore AJ, Delaney CP (2006) A critical analysis of laparoscopic colectomy at a single institution: lessons learned after 1000 cases. Am J Surg 191(3): 377–380

    Article  PubMed  Google Scholar 

  27. Senagore AJ, Duepree HJ, Delaney CP, Brady KM, Fazio VW (2003) Results of a standardized technique and postoperative care plan for laparoscopic sigmoid colectomy: a 30-month experience. Dis Colon Rectum 46: 503–509

    Article  PubMed  Google Scholar 

  28. Smedh K, Skullman S, Kald A, Anderberg B, Nystrom P (1997) Laparoscopic bowel mobilization combined with intraoperative colonoscopic polypectomy in patients with an inaccessible polyp of the colon. Surg Endosc 11: 643–644

    Article  PubMed  CAS  Google Scholar 

  29. Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy AM (2005) COlon cancer Laparoscopic or Open Resection Study Group (COLOR). Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6(7): 477–484

    Article  PubMed  Google Scholar 

  30. Waye JD (1996) How big is too big? Gastrointest Endosc 43: 256–257

    Article  PubMed  CAS  Google Scholar 

  31. Young-Fadok TM, Radice E, Nelson H, Harmsen WS (2000) Benefits of laparoscopic-assisted colectomy for colon polyps: a case-matched series. Mayo Clin Proc 75: 344–348

    Article  PubMed  CAS  Google Scholar 

  32. Zucker KA, Pitcher DE, Martin DT, Ford RS (1994) Laparoscopic-assisted colon resection. Surg Endosc 8: 12–17; discussion 18

    Article  PubMed  CAS  Google Scholar 

  33. Zuro LM, McCulloch CS, Saclarides TJ (1992) Laparoscopic colotomy, polypectomy. Innovative minimally invasive procedure. AORN J 56(6): 1068–1073

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, Cleveland Clinic Foundation, 11100 Euclid Avenue, Cleveland, OH, 44106-5047, USA

    Naveen Pokala, Ravi P. Kiran & Karen Brady

  2. Division of Colorectal Surgery, Institute for Surgery and Innovation University Hospitals of Cleveland, Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106-5047, USA

    Conor P. Delaney

  3. Department of Surgery, Medical University of Ohio, Toledo, OH, USA

    Anthony J. Senagore

Authors
  1. Naveen Pokala
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Conor P. Delaney
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ravi P. Kiran
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Karen Brady
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anthony J. Senagore
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Conor P. Delaney.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pokala, N., Delaney, C.P., Kiran, R.P. et al. Outcome of laparoscopic colectomy for polyps not suitable for endoscopic resection. Surg Endosc 21, 400–403 (2007). https://doi.org/10.1007/s00464-006-9069-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-006-9069-8

Keywords

Search

Navigation