Additional colectomy after endoscopic excision of malignant polyps: is it always necessary?

IF 2.1 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford Pub Date : 2026-04-01 Epub Date: 2026-02-04 DOI:10.1016/j.suronc.2026.102361

Mariana Marques, Mariana Peyroteo, Luís Lencastre, André Vale Guimarães, Maria João Madeira-Cardoso, Paula Ferreira Pinto, José Carlos Pereira, Flávio Videira, Joaquim Abreu de Sousa

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引用次数: 0

Abstract

Background

Management of malignant colonic polyps following endoscopic excision remains controversial. Surgery is recommended after incomplete excision and/or in the presence of recognized risk factors. The objective of this study was to evaluate the short and long-term results of surgery following endoscopic excision of malignant colon polyps.

Materials and methods

We present a 6-year retrospective observational study, in a tertiary oncology center, analyzing all patients diagnosed with malignant colonic polyps after endoscopic excision, submitted to surgery between January 2015 and December 2020.

Results

124 patients were included. Four underwent polypectomy of 2 malignant polyps at the same time. Of the 128 endoscopic excision specimens, 75% (n = 96) were located at the sigmoid colon and 80.5% (n = 103) demonstrated more than one histological risk factor, namely, deep submucosal invasion (DSI) - >1000 μm, tumor budding, histological grade 2 or 3, lymphatic, venous or perineural invasion. An R0 resection was achieved in 77 (60.16%) endoscopic specimens. Of these, 25 had a single histological risk factor, the majority of which (n = 19; 76%) presenting with DSI. Of these 25 patients (R0 with only one risk factor), none had residual disease in the surgical specimen (local or nodal), and none had recurrence of the disease.

Conclusion

The absence of disease in the surgical specimen after endoscopic excision in patients with an R0 endoscopic resection with a single risk factor, namely DSI, suggests that surgery can be spared in this subset of patients.

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内镜下恶性息肉切除术后附加结肠切除术是否总是必要的？

背景：内镜下恶性结肠息肉切除术后的处理仍然存在争议。在不完全切除和/或存在公认的危险因素时，建议进行手术。本研究的目的是评估内镜下恶性结肠息肉切除术后的短期和长期结果。材料和方法：我们在一家三级肿瘤中心进行了一项为期6年的回顾性观察研究，分析了2015年1月至2020年12月期间所有经内镜切除诊断为恶性结肠息肉的患者。结果：纳入124例患者。4例同时行2个恶性息肉切除术。在128例内镜切除标本中，75% （n = 96）位于乙状结肠，80.5% （n = 103）表现出不止一种组织学危险因素，即粘膜下深部浸润(DSI) - >1000 μm，肿瘤出芽，组织学2级或3级，淋巴，静脉或神经周围浸润。77例（60.16%）内镜标本实现R0切除。其中，25例有单一组织学危险因素，其中大多数（n = 19; 76%）表现为DSI。在这25例患者中（R0只有一个危险因素），手术标本中没有残留疾病（局部或淋巴结），也没有疾病复发。结论：对于R0内镜切除且危险因素单一（DSI）的患者，内镜切除后手术标本无病变，提示该亚群患者可以省去手术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Surgical Oncology-Oxford 医学-外科

CiteScore

4.50

自引率

0.00%

发文量

169

审稿时长

38 days

期刊介绍： Surgical Oncology is a peer reviewed journal publishing review articles that contribute to the advancement of knowledge in surgical oncology and related fields of interest. Articles represent a spectrum of current technology in oncology research as well as those concerning clinical trials, surgical technique, methods of investigation and patient evaluation. Surgical Oncology publishes comprehensive Reviews that examine individual topics in considerable detail, in addition to editorials and commentaries which focus on selected papers. The journal also publishes special issues which explore topics of interest to surgical oncologists in great detail - outlining recent advancements and providing readers with the most up to date information.