Published online Apr 16, 2024. doi: 10.4253/wjge.v16.i4.193
Peer-review started: November 29, 2023
First decision: December 27, 2023
Revised: January 28, 2024
Accepted: March 18, 2024
Article in press: March 18, 2024
Published online: April 16, 2024
Processing time: 133 Days and 13.9 Hours
Choosing an optimal post-polypectomy management strategy of malignant colorectal polyps is challenging, and evidence regarding a surveillance-only strategy is limited.
To evaluate long-term outcomes after endoscopic removal of malignant colorectal polyps.
A single-center retrospective cohort study was conducted to evaluate outcomes after endoscopic removal of malignant colorectal polyps between 2010 and 2020. Residual disease rate and nodal metastases after secondary surgery and local and distant recurrence rate for those with at least 1 year of follow-up were investigated. Event rates for categorical variables and means for continuous variables with 95% confidence intervals were calculated, and Fisher’s exact test and Mann-Whitney test were performed. Potential risk factors of adverse outcomes were determined with univariate and multivariate logistic regression models.
In total, 135 lesions (mean size: 22.1 mm; location: 42% rectal) from 129 patients (mean age: 67.7 years; 56% male) were enrolled. The proportion of pedunculated and non-pedunculated lesions was similar, with en bloc resection in 82% and 47% of lesions, respectively. Tumor differentiation, distance from resection margins, depth of submucosal invasion, lymphovascular invasion, and budding were reported at 89.6%, 45.2%, 58.5%, 31.9%, and 25.2%, respectively. Residual tumor was found in 10 patients, and nodal metastasis was found in 4 of 41 patients who underwent secondary surgical resection. Univariate analysis identified piecemeal resection as a risk factor for residual malignancy (odds ratio: 1.74; P = 0.042). At least 1 year of follow-up was available for 117 lesions from 111 patients (mean follow-up period: 5.59 years). Overall, 54%, 30%, 30%, 11%, and 16% of patients presented at the 1-year, 3-year, 5-year, 7-year, and 9-10-year surveillance examinations. Adverse outcomes occurred in 9.0% (local recurrence and dissemination in 4 patients and 9 patients, respectively), with no difference between patients undergoing secondary surgery and surveillance only.
Reporting of histological features and adherence to surveillance colonoscopy needs improvement. Long-term adverse outcome rates might be higher than previously reported, irrespective of whether secondary surgery was performed.
Core Tip: Despite recent advancements in endoscopy and the ability to perform optical diagnoses, submucosal invasion in colorectal polyps is often diagnosed at post-polypectomy histological evaluations. The reporting of high-risk histological features cannot serve as the sole basis of optimal post-polypectomy management strategy. Long-term adverse outcomes after endoscopic resection of malignant colorectal polyps might be more common than previously reported, irrespective of whether secondary surgery was performed. Therefore, adherence to post-polypectomy surveillance colonoscopy should be improved.