Current strategies for malignant pedunculated colorectal polyps

Abstract

Despite significant advances in imaging techniques, the incidence of colorectal cancer has been increasing in recent years, with many cases still being diagnosed in advanced stages. Early detection and accurate staging remain the main factors that lead to a decrease in the cost and invasiveness of the curative techniques, significantly improving the outcome. However, the diagnosis of pedunculated early colorectal malignancy remains a current challenge. Data on the management of pedunculated cancer precursors, apart from data on nonpolypoid lesions, are still limited. An adequate technique for complete resection, which provides the best long-term outcome, is mandatory for curative intent. In this context, a discussion regarding the diagnosis of malignancy of pedunculated polyps, separate from non-pedunculated variants, is necessary. The purpose of this review is to provide a critical review of the most recent literature reporting the different features of malignant pedunculated colorectal polyps, including diagnosis and management strategies.

Keywords: Pedunculated colorectal polyps; Malignant colorectal polyp; Early colorectal cancer; Polypoid early colon cancer; Advanced adenoma; Depth of invasion; Colorectal cancer; Polypectomy; Colorectal surgery; Early colorectal carcinoma

Core tip: Colorectal cancer has the highest chance of curability as long as it is detected at an early stage, before lymph node metastasis, or as a premalignant lesion. However, few relevant studies address pedunculated polyps separately from nonpolypoid type lesions, often resulting in a source of bias. The objective of this paper is to offer an up-to-date overview, particularly on the management of malignant pedunculated polyps.