Factors affecting long-term outcome of patients treated for malignant colorectal polyps: Endoscopic versus surgical treatment. A single center experience

BACKGROUND: A malignant polyp (MP) is an adenoma in which malignant cells invades the submucosa, but doesn’t extend into the muscularis propria. T1 polypoid colorectal cancer management represents a dilemma for surgeon: According to National Comprehensive Cancer Network (NCCN) guidelines, patients with any type of MP don’t require surgery if the polyp is completely removed endoscopically and has a favorable histology. For MPs with unfavorable histology or positive resection margin, NCCN guidelines recommend operative management. The primary goal of this study was to investigate trends and patterns in MP treatment. Secondary goal was to evaluate the outcome in patients treated. METHODS: We retrospectively analyzed the data of patients with MP detected and treated from 2002 to 2013 and prospectively stored on a database. RESULTS: During time frame considered, 2822 patients underwent colonoscopies. 143 were found to have MP. 52 of them had an endoscopic removal of the MP followed by endoscopic and 91 underwent surgery. All 143 patient were followed. Univariate analysis reveals factors predictive surgical approach. According to multivariate logistic regression analysis, the lesion site, organ invasion and positive resection margin were significantly related to choosing surgical approach. CONCLUSIONS: Surgical treatment for MP is influenced by the site of lesions, the resection margins involvement, and histological features of polyps. Following the international guidelines for MP the survival rate after the two therapeutic approaches isn’t significantly different. In patients treated with surgical resection, the finding of lymph node metastasis has a significant adverse impact on survival.