Assessing outcomes of full-thickness resection in piecemeal polypectomy scar consolidation of colon adenomas containing cancer.

Abstract

Background and study aims: The current standard of care for patients who are found to have malignancy within a resected colorectal polyp segment is surgical resection. Our study aimed to illustrate the efficacy and safety of using endoscopic full thickness resection (EFTR) to achieve histologically complete (R0) resection and formal staging in malignant polypectomy scars.

Patients and methods: This was a prospective case series of 14 patients who underwent scar consolidation via EFTR following piecemeal polypectomy or endoscopic mucosal resection (EMR) of a malignant colorectal polyp. Variables collected assessed R0 resection, technical success of the procedure, residual disease within the scar, recurrence during follow up, and adverse events (AEs).

Results: Of the 14 patient cases reviewed, there was 100% technical success and residual malignancy (RM) found in 14%. Of the two patients with residual disease, one achieved R0 resection with EFTR whereas the other did not and subsequently underwent surgery with no histopathological evidence of malignancy in the resected tissue. There was one AE of rectal bleeding that did not require any surgical intervention or blood transfusions.

Conclusions: EFTR could offer endoscopists a safe, efficacious, and minimally invasive mechanism for formal tumor (T) staging of malignancies found within polypectomy segments. Further studies with larger sample sizes are needed to assess outcomes in patients with residual neoplastic disease.