The choice of management after local resection of malignant polyps is based upon both disease- and patient-specific factors. This study set about to firstly investigate the incidence of colorectal cancer after endoscopic excision of polyps, and secondly compare the recurrence and mortality rates of those who underwent completion bowel surgery verse those who had surveillance.
A non-resectional approach is supported by the fact that the vast majority of locally removed malignant polyps are stage I cancers and generally associated with an excellent prognosis.
The decision to avoid resection can be aided by predicting nodal involvement using the Haggit or Kikuchi classifications and other histological factors; small size, early stage, Haggits level 1-3 or Sm1 complete resection, well-differentiated tumours, and absence of venous or lymphatic invasion all support surveillance.
Several other predictive factors can be considered such size, tumour differentiation, venous/lymphatic/perineural invasion, and budding. Nevertheless, clinicians often face a management dilemma because of the scarce evidence, and are understandably hesitant about local excision given the higher local recurrence rate reported in the literature.
Studies do, however, suggest that this is a poor surrogate for long-term survival as salvage surgery is often successful provided an intensive follow-up programme has been implemented.
The study therefore set about to investigate the incidence of unexpected colorectal cancer in polyps after endoscopic resection, and investigate the recurrence rate and mortality between patients who had completion surgery for early stage colorectal cancer and those who had organ preservation with endoscopic excision of and subsequent surveillance.
Description of the cohort
Patients with rectal cancer treated by a local resection with or without a completion low anterior resection at the department of colorectal surgery Odense University Hospital and Oxford University Hospital, UK, from 2008 until now.