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Surgical Management of Colorectal Polyps

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Colon Polyps and Colorectal Cancer

Abstract

Immediate diagnosis and treatment are available with colonoscopy for polyps which are considered as precursors of colorectal cancers. Treatment with low complication rates is possible as minimally invasive endoscopic methods are in use. Some polyps that are considered to be difficult to treat endoscopically should be evaluated and identified during colonoscopy, and appropriate treatment method can be selected accordingly. In the treatment of lesions that cannot be removed endoscopically, in the presence of suspected malignancy, surgical procedure in accordance with the oncological principles involving lymph node dissection can be performed laparoscopically with low complication rates.

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References

  1. Chen Z, Hu J, Zheng Z, Wang C, Lin D, Huang Y, Lan P, He X. Location of colorectal adenomas and serrated polyps in patients under age 50. Int J Colorectal Dis. 2019;34:2201–4.

    Article  Google Scholar 

  2. Brenner H, Kloor M, Pox CP. Colorectal cancer. Lancet. 2014;383:1490–502.

    Article  Google Scholar 

  3. Angarita FA, Feinberg AE, Feinberg SM, Riddell RH, McCart JA. Management of complex polyps of the colon and rectum. Int J Colorectal Dis. 2018;33:115–29.

    Article  Google Scholar 

  4. Ensari A, Bosman FT, Offerhaus GJ. The serrated polyp: getting it right! J Clin Pathol. 2010;63:665–8.

    Article  CAS  Google Scholar 

  5. Carethers JM, Stoffel EM, Orld J. Lynch syndrome and Lynch syndrome mimics: the growing complex landscape of hereditary colon cancer. World J Gastroenterol. 2015;21(31):9253–61.

    Article  CAS  Google Scholar 

  6. Wasif N, Etzioni D, Maggard MA, Tomlinson JS, Ko CY. Trends, patterns, and outcomes in the management of malignant colonic polyps in the general population of the United States. Cancer. 2011;117:931–7.

    Article  Google Scholar 

  7. Hunter J, Dunn D. Schwartz’s principles of surgery. 9th ed. New York: McGraw-Hill; 2010. p. 1042–3.

    Google Scholar 

  8. Akarsu M, Kones O. Clinical significance of diminutive colonic polyps in elderly patients. JSLS. 2018;22(4):e2018.00016.

    Article  Google Scholar 

  9. Consolo P, Luigiano C, Strangio G, Scaffidi MG, Giacobbe G, Di Giuseppe G, Zirilli A, Familiari L. Efficacy, risk factors and complications of endoscopic polypectomy: ten year experience at a single center. World J Gastroeneterol. 2008;14(15):2364–9.

    Article  Google Scholar 

  10. Kudo S, Lambert R, Allen JI, et al. Nonpolypoid neoplastic lesions of the colorectal mucosa. Gastrointest Endosc. 2008;68(4 Suppl):S3–S47.

    Article  Google Scholar 

  11. Bond JH. Practice Parameters Committee of the American College of Gastroenterology. Polyp guideline: diagnosis, treatment, and surveillance for patients with colorectal polyps. Am J Gastroenterol. 2000;95(11):3053–63.

    Article  CAS  Google Scholar 

  12. Rex DK, Shaukat A, Wallace MB. Optimal management of malignant polyps, from endoscopic assessment and resection to decisions about surgery. Clin Gastroenterol Hepatol. 2019;17:1428–37.

    Article  Google Scholar 

  13. Huang E, Sarin A. Colonic polyps: treatment. Clin Colon Rectal Surg. 2016;29:306–14.

    Article  Google Scholar 

  14. Vleugels JLA, Hazewinkel Y, Dekker E. Morphological classifications of gastrointestinal lesions. Best Pract Res Clin Gastroenterol. 2017;31:359–67.

    Article  Google Scholar 

  15. Li M, Ali SM, Umm-a-OmarahGilani S, Liu J, Li YQ, Zuo XL. Kudo’s pit pattern classification for colorectal neoplasms: a meta-analysis. World J Gastroenterol. 2014;20(35):12649–56.

    Article  Google Scholar 

  16. Facciorusso A, Antonino M, Di Maso M, Barone M, Muscatiello N. Non-polypoid colorectal neoplasms: classification, therapy and follow-up. World J Gastroenterol. 2015;21(17):5149–57.

    Article  Google Scholar 

  17. Jung YS, Park JH, Kim HJ, Cho YK, Sohn CI, Jeon WK, Kim BI, Sohn JH, Park DI. Complete biopsy resection of diminutive polyps. Endoscopy. 2013;45(12):1024–9.

    Article  Google Scholar 

  18. Park SK, Ko BM, Han JP, Hong SJ, Lee MS. A prospective randomized comparative study of cold forceps polypectomy by using narrow-band imaging endoscopy versus cold snare polypectomy in patients with diminutive colorectal polyps. Gastrointest Endosc. 2016;83(3):527–32.e1.

    Article  Google Scholar 

  19. Efthymiou M, Taylor AC, Desmond PV, Allen PB, Chen RY. Biopsy forceps is inadequate for the resection of diminutive polyps. Endoscopy. 2011;43(4):312–6. https://doi.org/10.1055/s-0030-1256086.

    Article  CAS  Google Scholar 

  20. Tappero G, Gaia E, De Giuli P, Martini S, Gubetta L, Emanuelli G. Cold snare excision of small colorectal polyps. Gastrointest Endosc. 1992;38:310–3.

    Article  CAS  Google Scholar 

  21. Yamashina T, Fukuhara M, Maruo T, et al. Cold snare polypectomy reduced delayed postpolypectomy bleeding compared with conventional hot polypectomy: a propensity score-matching analysis. Endosc Int Open. 2017;5:E587–94.

    Article  Google Scholar 

  22. Kim JS, Lee BI, Choi H, et al. Cold snare polypectomy versus cold forceps polypectomy for diminutive and small colorectal polyps: a randomized controlled trial. Gastrointest Endosc. 2015;81:741–7.

    Article  Google Scholar 

  23. Hewett DG. Cold snare polypectomy: optimizing technique and technology (with videos). Gastrointest Endosc. 2015;82:693–6.

    Article  Google Scholar 

  24. Horiuchi A, Ikuse T, Tanaka N. Cold snare polypectomy: indications, devices, techniques, outcomes and future. Dig Endosc. 2019;31(4):372–7. https://doi.org/10.1111/den.13314.

    Article  Google Scholar 

  25. Dragnov PV. Colonoscopic polypectomy and associated techniques. World J Gastroenterol. 2010;16(29):3630–7.

    Article  Google Scholar 

  26. Panteris V, Vezakis A, Triantafillidis JK. Should hot biopsy forceps be abandoned for polypectomy of diminutive colorectal polyps? World J Gastroenterol. 2018;24(14):1579–82.

    Article  Google Scholar 

  27. Yasar B, Kayadibi H, Abut E, Benek D, Kochan K, Gonen C. The histological quality and adequacy of diminutive colorectal polyps resected using jumbo versus hot biopsy forceps. Dig Dis Sci. 2015;60(1):217–25. https://doi.org/10.1007/s10620-014-3320-2.

    Article  Google Scholar 

  28. Monica F, Pecoraro GM. Colonoscopic polypectomy: techniques and new method. Adv Res Gastroenterol Hepatol. 2017;4(5):555650.

    Article  Google Scholar 

  29. Jegadeesan R, Aziz M, Desai M, Sundararajan T, Gorrepati V, Chandrasekar VT, Jayaraj M, Singh P, Saeed A, Rai T, Choudhary A, Repici A, Hassan C, Fuccio L, Sharma P. Hot snare vs. cold snare polypectomy for endoscopic removal of 4–10 mm colorectal polyps during colonoscopy: a systematic review and meta-analysis of randomized controlled studies. Endosc Int Open. 2019;7(5):E708–16.

    Article  Google Scholar 

  30. Yamashina T, Fukuhara M, Maruo T, et al. Cold snare polypectomy reduced delayed postpolypectomy bleeding compared with conventional hot polypectomy: a propensity score-matching analysis. Endosc Int Open. 2017;05:E587–94.

    Article  Google Scholar 

  31. Repici A, Hassan C, Vitetta E, et al. Safety of cold polypectomy for <10 mm polyps at colonoscopy: a prospective multicenter study. Endoscopy. 2011;44:27–31.

    Article  Google Scholar 

  32. Gallegos-Orozco JF, Gurudu SR. Complex colon polypectomy. Gastroenterol Hepatol. 2010;6(6):375–82.

    Google Scholar 

  33. Gupta S, Miskovic D, Bhandari P, et al. The “SMSA” scoring system for determining the complexity of a polyp. Gut. 2011;60:A129.

    Article  Google Scholar 

  34. Tholoor S, Tsagkournis O, Basford P, Bhandari P. Managing difficult polyps: techniques and pitfalls. Ann Gastroenterol. 2013;26(2):114–21.

    Google Scholar 

  35. Raju G, Lum P, Ross W, Thirumurthi S, Miller E, Lynch P, Lee J, et al. Outcome of endoscopic mucosal resection as an alternative to surgery in patients with complex colon polyps. Gastrointest Endosc. 2016;84(2):315–25.

    Article  Google Scholar 

  36. Moss A, Kumanan N. Standardisation of polypectomy technique. Best Pract Res Clin Gastroenterol. 2017;31:447–53.

    Article  Google Scholar 

  37. Kandel P, Wallace MB. Colorectal endoscopic mucosal resection (EMR). Best Pract Res Clin Gastroenterol. 2017;31:455–71.

    Article  Google Scholar 

  38. Macrae FA, Tan K, Williams CB. Towards safer colonoscopy: a report on the complications of 5000 diagnostic or therapeutic colonoscopies. Gut. 1983;24:376–83.

    Article  CAS  Google Scholar 

  39. Inoue H, Takeshita K, Hori H, et al. Endoscopic mucosal resection with a cap-fitted panendoscope for esophagus, stomach, and colon mucosal lesions. Gastrointest Endosc. 1993;39:58–62.

    Article  CAS  Google Scholar 

  40. Aslan F, Alper E, Akpinar Z, Ekinci N, Şeren AR, Küçük M, Ünsal B. Treatment of laterally spreading tumor in the rectum and sigmoid colon by endoscopic submucosal dissection: a case report. Akademik Gastroenteroloji Dergisi. 2013;12(3):127–30.

    Google Scholar 

  41. Cengiz C. Submukozal Diseksiyon ve Endoskopik Submukozal Cerrahiye Güncel Bir Bakış ve Güney Kore Gözlemleri. Güncel Gastroenteroloji 16(4):242–249.

    Google Scholar 

  42. Bertelson NL, Alkbrenner KA, Merchea A, et al. Colectomy for endoscopically unresectable polyps; how often is it cancer? Dis Colon Rectum. 2012;55(11):1111–6.

    Article  Google Scholar 

  43. Aarons CB, Shanmugan S, Bleier JIS. Management of malignant colon polyps: current status and controversies. World J Gastroenterol. 2014;20(43):16178–83. https://doi.org/10.3748/wjg.v20.i43.16178.

    Article  Google Scholar 

  44. Cowan M, Silviera ML. Management of rectal polyps. Clin Colon Rectal Surg. 2016;29(4):315–20. https://doi.org/10.1055/s-0036-1582438.

    Article  Google Scholar 

  45. Loungnarath R, Mutch MG, Birnbaum EH, Read TE, Fleshmen JW. Laparoscopic colectomy using cancer principles is appropriate for colonoscopically unresectable adenomas of colon. Dis Colon Rectum. 2010;53:1017–22.

    Article  Google Scholar 

  46. Dulskas A, Kuliesius Z, Samalavicius NE. Laparoscopic colorectal surgery for colorectal polyps: experience of ten years. Acta Medica Lituanica. 2017;24(1):18–24.

    Article  Google Scholar 

  47. Wang R, Wang Y, Li D, Yu L, Liu G, Ma J, Wang W. Application of carbon nanoparticles to mark locations for re-inspection after colonic polypectomy. Surg Endosc. 2016;30(4):1530–3.

    Article  Google Scholar 

  48. Uraoka T, Saito Y, Matsuda T, Ikehara H, Gotoda T, Saito D, Fujii T. Endoscopic indications for endoscopic mucosal resection of laterally spreading tumours in the colorectum. Gut. 2006;55(11):1592–7.

    Article  CAS  Google Scholar 

  49. Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc. 1991;1(3):144–50.

    CAS  Google Scholar 

  50. Whealon M, Vinci A, Pigazzi A. Future of minimally invasive colorectal surgery. Clin Colon Rectal Surg. 2016;29(3):221–31.

    Article  Google Scholar 

  51. Millo P, Rispoli C, Rocco N, Contul RB, Fabozzi M, Grivon M, Nardi MJ, Allieta R. Laparoscopic surgery for colon cancer. Ann Gastroenterol. 2013;26(3):198–203.

    Google Scholar 

  52. Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart RW Jr, Hellinger M, Flanagan R Jr, Peters W, Nelson H. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Clinical outcomes of surgical therapy study group. Ann Surg. 2007;246(4):655–62; discussion 662–4.

    Article  Google Scholar 

  53. Michalopoulos NV, Theodoropoulos GE, Stamopoulos P, Sergentanis TN, Memos N, Tsamis D, Flessas I, Menenakos E, Kontodimopoulos N, Zografos GC. A cost-utility analysis of laparoscopic vs open colectomy of colorectal cancer in a public hospital of the Greek National Health System. J BUON. 2013;18(1):86–97.

    CAS  Google Scholar 

  54. Fleshman JW, Fry RD, Birnbaum EH, Kodner IJ. Laparoscopic-assisted and minilaparotomy approaches to colorectal diseases are similar in early outcome. Dis Colon Rectum. 1996;39:15–22.

    Article  CAS  Google Scholar 

  55. Vormbrock K, Mönkemüller K. Difficult colon polypectomy. World J Gastrointest Endosc. 2012;4(7):269–80.

    Article  Google Scholar 

  56. Chang YJ, Marcello PW, Rusin LC, Roberts PL, Schoetz DJ. Hand-assisted laparoscopic sigmoid colectomy: helping hand or hindrance? Surg Endosc. 2005;19(5):656–61.

    Article  Google Scholar 

  57. Tajima T, Mukai M, Yamazaki M, Higami S, Yamamoto S, Hasegawa S, Nomura E, Sadahiro S, Yasuda S, Makuuchi H. Comparison of hand-assisted laparoscopic surgery and conventional laparotomy for colorectal cancer: interim results from a single institution. Oncol Lett. 2014;8(2):627–32.

    Article  Google Scholar 

  58. Garrett KA, Lee SW. Combined endoscopic and laparoscopic surgery. Clin Colon Rectal Surg. 2015;28:140–5.

    Article  Google Scholar 

  59. Placek SB, Nelson J. Combined endoscopic laparoscopic surgery procedures for colorectal surgery. Clin Colon Rectal Surg. 2017;30:145–50.

    Article  Google Scholar 

  60. Lee MK, Chen F, Esrailian E, Russel MM, Sack J, Lin AY, Yoo J. Combined endoscopic and laparoscopic surgery may be an alternative to bowel resection for the management of colon polyps not removable by standard colonoscopy. Surg Endosc. 2013;27(6):2082–6.

    Article  Google Scholar 

  61. Al-Najami I, Rancinger CP, Larsen MK, Thomassen N, Buch N, Baatrup G. Transanal endoscopic microsurgery for advanced polyps and early cancers in the rectum—long-term outcome: a STROBE compliant observational study. Medicine (Baltimore). 2016;95(36):e4732.

    Article  Google Scholar 

  62. Heidary B, Phang TP, Raval MJ, Brown CJ. Transanal endoscopic microsurgery: a review. Can J Surg. 2014;57(2):127–37.

    Article  Google Scholar 

  63. Rai V, Mishra N. Transanal approach to rectal polyps and cancer. Clin Colon Rectal Surg. 2016;29(1):65–70.

    Google Scholar 

  64. Levic K, Bulut O, Hesselfeldt P. Transanal endoscopic microsurgery for giant polyps of the rectum. Tech Coloproctol. 2014;18:521–7. https://doi.org/10.1007/s10151-013-1069-9.

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Esin, H., Ekici, M.F., Calik, B. (2021). Surgical Management of Colorectal Polyps. In: Engin, O. (eds) Colon Polyps and Colorectal Cancer. Springer, Cham. https://doi.org/10.1007/978-3-030-57273-0_8

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  • DOI: https://doi.org/10.1007/978-3-030-57273-0_8

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