Conduite à tenir après résection endoscopique d’un polype dégénéré

摘要

Following endoscopic complete resection of a cancerous polyp, there is no surgical indication in case of intramucosal cancer. In the situation of sub-mucosal infiltrating cancer, 5 major histologic criteria are in favour of complementary surgery, whenever the patient’s status allows this option: the presence of lymphatic or vascular invasion, a grade III histology, sub-mucosal invasion > 1000 μM, and the absence of an at least 1 mm clear margin. The presence of budding (undifferentiated or aggressive tumor cell foci at the tumor margin) is a new criteria needing further validation. In the absence of these negative criteria, the endoscopic treatment can be considered as satisfying on a carcinologic point of view, knowing the very low risk of residual disease to be balanced with the surgical risk. Rectal cancers invading the submucosa could be at higher risk of recurrence than colon cancers.