Risk factor assessment of endoscopically removed malignantcolorectal polyps

摘要

Background—Malignant colorectal polyps are defined as endoscopically removed polyps with cancerous tissue which has invaded the submucosa. Various histological criteria exist for managing these patients.
Aims—To determine the significance of histological findings of patients with malignant polyps.
Methods—Five pathologists reviewed the specimens of 85 patients initially diagnosed with malignant polyps. High risk malignant polyps were defined as having one of the following: incomplete polypectomy, a margin not clearly cancer-free, lymphatic or venous invasion, or grade III carcinoma. Adverse outcome was defined as residual cancer in a resection specimen and local or metastatic recurrence in the follow up period (mean 67months).
Results—Malignant polyps were confirmed in 70 cases. In the 32 low risk malignant polyps, no adverse outcomes occurred; 16(42%) of the 38 patients with high risk polyps had adverse outcomes (p<0.001). Independent adverse risk factors were incomplete polypectomy and a resected margin not clearly cancer-free; all other risk factors were only associated with adverse outcome when in combination.
Conclusion—As no patients with low risk malignant polyps had adverse outcomes, polypectomy alone seems sufficient forthese cases. In the high risk group, surgery is recommended when either of the two independent risk factors, incomplete polypectomy or aresection margin not clearly cancer-free, is present or if there is acombination of other risk factors. As lymphatic or venous invasion orgrade III cancer did not have an adverse outcome when the sole riskfactor, operations in such cases should be individually assessed on thebasis of surgical risk.

Keywords:malignant polyps; colon cancer; colonoscopy; polypectomy; histology