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Colectomy for endoscopically unresectable polyps: how often is it cancer?
MedLine Citation:
PMID:  23044670     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: : Colonoscopy has an established role in reducing the burden of colorectal cancer through early detection and removal of polyps. For endoscopically unresectable polyps, colectomy is generally indicated to prevent malignant transformation or to remove cancer already present.
OBJECTIVE: : This study aimed to determine the incidence of malignancy and the factors predictive of malignancy in surgically resected benign polyps. DESIGN/PATIENTS/SETTING:: This study was a retrospectivechart review of patients undergoing a colectomy for a colonic polyp (no preoperative diagnosis of cancer) in 4 hospitals within the Mayo Clinic Health System.
MAIN OUTCOME MEASURES: : Patient characteristics, endoscopic location and size, and preoperative and operative polyp pathology were tabulated. Correlations between these features and the finding of invasive carcinoma on surgical pathology were assessed.
RESULTS: : A total of 750 patients met our inclusion criteria. Patients were predominantly male (55.2%) with an average age of 69.4 ± 9.8 years. A majority of polyps were located in the right colon (70.9%). Invasive cancer was identified in 133 patients (17.7%). Multivariate analysis revealed polyps in the left colon (adjusted OR 2.13, 95% CI (1.22-3.72)), and those with high-grade dysplasia (adjusted OR 4.60, 95% CI (2.91-7.27)) were more likely to harbor carcinoma. Age, sex, polyp dimension, and villous features were not predictive of malignancy. Of the patients with cancer, 31 (23.3%) had nodal disease.
LIMITATIONS: : This study is limited by its retrospective nature, the change in terminology and technique over time, and the partially subjective nature of an endoscopically unresectable polyp.
CONCLUSIONS: : The finding that polyp size and villous features do not strongly predict malignancy differs from previous endoscopic studies. This study confirms that polyps located in the left colon or with high-grade dysplasia are more likely to harbor cancer. The results of this study suggest that endoscopically unresectable polyps are best treated by radical oncologic resection.
Authors:
Noelle L Bertelson; Kristen A Kalkbrenner; Amit Merchea; Eric J Dozois; Ron G Landmann; Giovanni De Petris; Tonia M Young-Fadok; David A Etzioni
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Diseases of the colon and rectum     Volume:  55     ISSN:  1530-0358     ISO Abbreviation:  Dis. Colon Rectum     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-10-09     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372764     Medline TA:  Dis Colon Rectum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1111-6     Citation Subset:  IM    
Affiliation:
1Department of Surgery, Mayo Clinic, Scottsdale, Arizona 2Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota 3Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, Florida 4Department of Pathology, Mayo Clinic, Scottsdale, Arizona.
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