Most benign-appearing colonic polyps prove benign on final pathology

Last Updated: 2016-07-14

By Will Boggs MD

NEW YORK (Reuters Health) - Most colon polyps that appear benign but are unresectable by endoscopy are shown to be benign on final surgical pathology, researchers report.

Some colorectal polyps are not suitable for conventional colonoscopic removal, and there is ongoing debate on the best approach for endoscopically benign large polyps that can't be readily removed. A key determinant becomes the chance of cancer in such lesions.

Dr. Emre Gorgun and colleagues from Cleveland Clinic in Ohio used data from their prospectively maintained electronic cancer and laparoscopy databases to estimate the cancer risk in 439 patients with endoscopically benign unresectable colonic polyps referred for surgery.

On preoperative evaluation, 88 patients (20%) were found to have high-grade dysplasia, and the remainder were benign, according to the June 30 Journal of the American College of Surgeons online report.

Cancer was identified on the operative specimen in 37 patients (8.4%), and the preoperative high-grade dysplasia rate was significantly higher in these patients (48.0%) than in those whose polyps were shown to be benign (17.4%).

Patients with and without cancer were comparable in terms of lesion location, histology, and morphology.

Mean overall survival was 52 months, but only one patient died from colorectal cancer.

About one in five patients developed complications within 30 days of surgery, and complication rates were the same (18.9%) in the benign and malignant groups.

"In a patient with an endoscopically unresectable colorectal polyp that looks benign both by appearance and histology, local excision is usually oncologically safe," the researchers conclude. "Therefore, we suggest that advanced polypectomy techniques such as endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), or laparoscopic assisted approach should be considered to preserve the colon if there is not high suspicion for cancer. The presence of cancer should be treated surgically using oncologic principles and techniques."

Dr. Gorgun did not respond to a request for comments.

The authors reported no funding or disclosures.

SOURCE: http://bit.ly/29RCxxS

J Am Coll Surg 2016.