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  • Title: Rate of residual disease after complete endoscopic resection of malignant colonic polyp.
    Author: Butte JM, Tang P, Gonen M, Shia J, Schattner M, Nash GM, Temple LK, Weiser MR.
    Journal: Dis Colon Rectum; 2012 Feb; 55(2):122-7. PubMed ID: 22228153.
    Abstract:
    BACKGROUND: Following polypectomy, colectomy is performed selectively to ensure complete clearance of neoplasia. OBJECTIVE: This study aimed to determine the risk factors associated with residual disease at colectomy following malignant polypectomy. DESIGN: This is a retrospective study. SETTING: This investigation took place at a tertiary teaching cancer center. PATIENTS: Consecutive patients undergoing polypectomy followed by colectomy from 1990 to 2007 were identified from a prospective database. MAIN OUTCOME MEASURES: Factors associated with residual disease at colectomy were associated with clinicopathologic features. RESULTS: Colectomy following polypectomy was performed in 143 patients: 127 with clear invasion of polyp submucosa (invasive disease), and 16 suspicious for submucosal invasion. Residual disease after colectomy was diagnosed in 27 (19%) of 143 patients. Disease was present in the colonic wall in 19 patients (13%): invasive in 16 (11%), and noninvasive in 3 (2.1%). Of the 16 patients with residual invasive disease at colectomy, 15 had clearly invasive disease at polypectomy and 1 was suspicious for invasive disease at polypectomy. Lymph node metastasis was noted in 10 (7.0%) patients. When analyzing patients with clearly invasive disease at polypectomy by margin status, residual invasive disease in the colon wall was noted in 8 of 50 (16%) with <1 mm (positive) polypectomy margin, 7 of 33 (21%) with indeterminate polypectomy margin, and 0 of 44 with ≥1 mm (negative) polypectomy margin (p = 0.009). Nodal metastasis was associated with the presence of lymphovascular invasion (p = 0.01). LIMITATIONS: This study is limited by its retrospective nature and selection bias. CONCLUSIONS: Following malignant polypectomy, colectomy should be considered in medically fit patients if the polypectomy margin is positive (≤1 mm) or unknown, or if lymphovascular invasion is present.
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