Large bowel adenomas.

The last 20 years have witnessed dramatic technological advances in the diagnosis and treatment of colorectal polyps. These developments, in addition to an increased understanding of large bowel carcinogenesis, have shifted the risk/benefit balance toward a more aggressive approach to colorectal polyps. Mounting evidence for the adenoma-carcinoma sequence supports the position that all colorectal polyps should be removed, recovered, and evaluated. Moreover, in most cases polypectomy can be achieved endoscopically. To justify surgery today, adenomas must be too large to be removed endoscopically, located in the distal rectum, or malignant with submucosal invasion or questionable margins.