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Malignant colorectal polyps: endoscopic polypectomy and watchful waiting is not inferior to subsequent bowel resection. A nationwide propensity score-based analysis

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Abstract

Background and aims

The optimal treatment of patients with malignant colorectal polyps is unsettled. The surgical dilemma following polypectomy is selecting between watchful waiting (WW) and subsequent bowel resection (SBR), but the long-term survival outcomes have not been established yet. This nationwide study compared survival of patients after WW or SBR.

Methods

Danish nationwide study with 100% follow-up of all patients with malignant colorectal polyps (the Danish Colorectal Cancer Group database) in a 10-year period from 2001 to 2011. All patients’ charts and histological reports were individually reviewed. Survival rates were calculated with Cox proportional hazard model after propensity score matching.

Results

A total of 692 patients were included (WW, 424 (61.3%), SBR, 268 (38.7%)) with a mean follow-up of 7.5 years (3–188 months). Following propensity score matching, there was no significant difference in overall or disease-free survival (p = 0.344 and p = 0.184) or rate of local recurrence (WW, 7.2%, SBR, 2%, p = 0.052) or distant metastases (WW, 3.3%, SBR, 4.6%, p = 0.77). In the SBR group, there was no residual tumor or lymph node metastases in the resected specimen in 82.5% of the patients.

Conclusion

Subsequent bowel resection may not be superior to endoscopic polypectomy and watchful waiting with regard to overall and disease-free survival in patients with malignant colorectal polyps.

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Abbreviations

WW:

Watchful waiting

SBR:

Subsequent bowel resection

TRUS:

Transanal endoscopic ultrasound

MRI:

Magnetic resonance imaging

pT:

Pathological T-stage of tumor

SD:

Standard deviation

ASA-score:

American Society of Anesthesiologists’ score

BMI:

Body mass index (kg/m2)

CCI:

Charlson comorbidity index

OS:

Overall survival

DFS:

Disease-free survival

OR:

Odds ratio

CI:

Confidence interval

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Authors and Affiliations

  1. Gastrounit—Surgical Division, Center for Surgical Research, Copenhagen University Hospital Hvidovre, Kettegaards Allé 30, DK-2650 Hvidovre, Copenhagen, Denmark

    Katarina Levic, Orhan Bulut & Thue Bisgaard

  2. Institution of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

    Orhan Bulut, Tine Plato Hansen, Ismail Gögenur & Thue Bisgaard

  3. Department of Pathology, Herlev University Hospital, Copenhagen, Denmark

    Tine Plato Hansen

  4. Center for Surgical Science, Department of Surgery, Zealand University Hospital, Køge, Denmark

    Ismail Gögenur

  5. Danish Colorectal Cancer Group, Copenhagen, Denmark

    Tine Plato Hansen & Ismail Gögenur

Authors
  1. Katarina Levic
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  2. Orhan Bulut
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  3. Tine Plato Hansen
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  4. Ismail Gögenur
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  5. Thue Bisgaard
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Correspondence to Katarina Levic.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants performed by any of the authors (retrospective study). The study was approved by the National Committee on Health Research and reported to Danish Data Protection Agency.

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Tine Plato Hansen and Ismail Gögenur are part of the Danish Colorectal Cancer Group

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Levic, K., Bulut, O., Hansen, T.P. et al. Malignant colorectal polyps: endoscopic polypectomy and watchful waiting is not inferior to subsequent bowel resection. A nationwide propensity score-based analysis. Langenbecks Arch Surg 404, 231–242 (2019). https://doi.org/10.1007/s00423-018-1706-x

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