Abstract
One hundred fifty-one patients with colorectal polyps containing invasive adenocarcinoma treated by resection were studied to determine the incidence of lymph node metastasis and whether lymph node metastasis was related to the depth of invasion. Other variables evaluated included size and configuration of the polyp, grade of adenocarcinoma, presence or absence of lymphovascular invasion, and degree of differentiation. In patients with sessile polyps, the incidence of lymph node metastasis was 10 percent. Eighty percent of these lesions had lymphovascular invasion. For pedunculated polyps, the overall incidence of lymph node metastasis was 6 percent. However, there was no incidence of lymph node metastasis when the depth of invasion was limited to the head, neck, and stalk of the polyp (Levels 1, 2, and 3). Only when the depth of invasion reached to the base of the stalk (Level 4) was the risk of lymph node metastasis high (27 percent). The other risk factors were not associated with lymph node metastasis. We concluded that the most significant risk factor for lymph node metastasis in patients with invasive carcinoma in a polyp was invasion into the submucosa of the bowel wall (Level 4).
Similar content being viewed by others
References
Colacchio TA, Forde KA, Scantlebury VP. Endoscopic polypectomy: inadequate treatment for invasive colorectal carcinoma. Ann Surg 1981;194:704–7.
Lipper S, Kahn LB, Ackerman LV. The significance of microscopic invasive cancer in endoscopically removed polyps of the large bowel: a clinico-pathologic study of 51 cases. Cancer 1983;52:1691–9.
Morson BC, Whiteway JE, Jones EA, Macrae FA, Williams CB. Histopathology and prognosis of malignant colorectal polyps treated by endoscopic polypectomy. Gut 1984;25:437–44.
Langer JC, Cohen Z, Taylor BR, Stafford S, Jeejeebhoy KN, Cullen JB. Management of patients with polyps containing malignancy removed by colonoscopic polypectomy. Dis Colon Rectum 1984;27:6–9.
Riddell RH. Hands off “cancerous” large bowel polyps. Gastroenterology 1985;89:432–41.
Fucini C, Wolff BG, Spencer RJ. An appraisal of endoscopic removal of malignant colonic polyps. Mayo Clinic Proc 1986;61:123–6.
Christie JP. Polypectomy or colectomy? Management of 106 consecutively encountered colorectal polyps. Am Surg 1988;54:93–9.
Cranley JP, Petras RE, Carey WD, Paradis K, Sivak MV. When is endoscopic polypectomy adequate therapy for colonic polyps containing invasive carcinoma? Gastroenterology 1986;91:419–27.
Muto T, Sawada T, Sugihara K. Treatment of carcinoma in adenomas. World J Surg 1991;15:35–40.
Coutsoftides T, Sivak MV Jr, Benjamin SP, Jagelman D. Colonoscopy and the management of polyps containing invasive carcinoma. Ann Surg 1978;188:638–41.
Nivatvongs S. Management of polyps containing invasive carcinoma. In: Kodner IJ, Fry RD, Roe JP eds. Colon, rectal, and anal Surgery. St. Louis: CV Mosby, 1985:173–80.
Waye JD. Colon polyps: problems, promises, prospects. Am J Gastroenterol 1986;81:101–3.
Richards WO, Webb WA, Morris SJ, et al. Patient management after endoscopic removal of the cancerous colon adenoma. Ann Surg 1987;205:665–72.
Haggitt RC, Glotzbach RE, Soffer EE, Wruble LD. Prognostic factors in colorectal carcinomas arising in adenomas: implications for lesions removed by endoscopic polypectomy. Gastroenterology 1985;89:328–36.
Coverlizza S, Risio M, Ferrari A, Fenoglio-Preiser CM, Rossini FP. Colorectal adenomas containing invasive carcinoma: pathologic assessment of lymph node metastatic potential. Cancer 1989;64:1937–47.
Cooper HS. Surgical pathology of endoscopically removed malignant polyps of the colon and rectum. Am J Surg Pathol 1983;7:613–23.
Author information
Authors and Affiliations
About this article
Cite this article
Nivatvongs, S., Rojanasakul, A., Reiman, H.M. et al. The risk of lymph node metastasis in colorectal polyps with invasive adenocarcinoma. Dis Colon Rectum 34, 323–328 (1991). https://doi.org/10.1007/BF02050592
Issue Date:
DOI: https://doi.org/10.1007/BF02050592