Katarina Levic1, Orhan Bulut2,3, Tine Plato Hansen3,4,5, Ismail Gögenur3,6,5, Thue Bisgaard2,3. 1. Gastrounit-Surgical Division, Center for Surgical Research, Copenhagen University Hospital Hvidovre, Kettegaards Allé 30, DK-2650 Hvidovre, Copenhagen, Denmark. katarina.levic@gmail.com. 2. Gastrounit-Surgical Division, Center for Surgical Research, Copenhagen University Hospital Hvidovre, Kettegaards Allé 30, DK-2650 Hvidovre, Copenhagen, Denmark. 3. Institution of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. 4. Department of Pathology, Herlev University Hospital, Copenhagen, Denmark. 5. Danish Colorectal Cancer Group, Copenhagen, Denmark. 6. Center for Surgical Science, Department of Surgery, Zealand University Hospital, Køge, Denmark.
Abstract
BACKGROUND AND AIMS: The optimal treatment of patients with malignant colorectal polyps is unsettled. The surgical dilemma following polypectomy is selecting between watchful waiting (WW) and subsequent bowel resection (SBR), but the long-term survival outcomes have not been established yet. This nationwide study compared survival of patients after WW or SBR. METHODS: Danish nationwide study with 100% follow-up of all patients with malignant colorectal polyps (the Danish Colorectal Cancer Group database) in a 10-year period from 2001 to 2011. All patients' charts and histological reports were individually reviewed. Survival rates were calculated with Cox proportional hazard model after propensity score matching. RESULTS: A total of 692 patients were included (WW, 424 (61.3%), SBR, 268 (38.7%)) with a mean follow-up of 7.5 years (3-188 months). Following propensity score matching, there was no significant difference in overall or disease-free survival (p = 0.344 and p = 0.184) or rate of local recurrence (WW, 7.2%, SBR, 2%, p = 0.052) or distant metastases (WW, 3.3%, SBR, 4.6%, p = 0.77). In the SBR group, there was no residual tumor or lymph node metastases in the resected specimen in 82.5% of the patients. CONCLUSION: Subsequent bowel resection may not be superior to endoscopic polypectomy and watchful waiting with regard to overall and disease-free survival in patients with malignant colorectal polyps.
BACKGROUND AND AIMS: The optimal treatment of patients with malignant colorectal polyps is unsettled. The surgical dilemma following polypectomy is selecting between watchful waiting (WW) and subsequent bowel resection (SBR), but the long-term survival outcomes have not been established yet. This nationwide study compared survival of patients after WW or SBR. METHODS: Danish nationwide study with 100% follow-up of all patients with malignant colorectal polyps (the Danish Colorectal Cancer Group database) in a 10-year period from 2001 to 2011. All patients' charts and histological reports were individually reviewed. Survival rates were calculated with Cox proportional hazard model after propensity score matching. RESULTS: A total of 692 patients were included (WW, 424 (61.3%), SBR, 268 (38.7%)) with a mean follow-up of 7.5 years (3-188 months). Following propensity score matching, there was no significant difference in overall or disease-free survival (p = 0.344 and p = 0.184) or rate of local recurrence (WW, 7.2%, SBR, 2%, p = 0.052) or distant metastases (WW, 3.3%, SBR, 4.6%, p = 0.77). In the SBR group, there was no residual tumor or lymph node metastases in the resected specimen in 82.5% of the patients. CONCLUSION: Subsequent bowel resection may not be superior to endoscopic polypectomy and watchful waiting with regard to overall and disease-free survival in patients with malignant colorectal polyps.
Entities:
Keywords:
Cancer in adenomas; Malignant polyp; Polypectomy; pT1 colorectal cancer
Authors: Tiing Leong Ang; Jit Fong Lim; Tju Siang Chua; Kok Yang Tan; James Weiquan Li; Chern Hao Chong; Kok Ann Gwee; Vikneswaran S/O Namasivayam; Charles Kien Fong Vu; Christopher Jen Lock Khor; Lai Mun Wang; Khay Guan Yeoh Journal: Singapore Med J Date: 2020-07-16 Impact factor: 3.331
Authors: Andrew P Zammit; Nicholas J Lyons; Mark D Chatfield; John D Hooper; Ian Brown; David A Clark; Andrew D Riddell Journal: Int J Colorectal Dis Date: 2022-04-08 Impact factor: 2.796