Colectomy for endoscopically unresectable polyps: How often is it cancer

Noelle L. Bertelson, Kristen A. Kalkbrenner, Amit Merchea, Eric Dozois, Ron G. Landmann, Giovanni De Petris, Tonia M. Young-Fadok, David A. Etzioni

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

BACKGROUND: Colonoscopy has an established role in reducing the burden of colorectal cancer through early detection and removal of polyps. For endoscopically unresectable polyps, colectomy is generally indicated to prevent malignant transformation or to remove cancer already present. OBJECTIVE: This study aimed to determine the incidence of malignancy and the factors predictive of malignancy in surgically resected benign polyps. DESIGN/PATIENTS/SETTING: This study was a retrospective chart review of patients undergoing a colectomy for a colonic polyp (no preoperative diagnosis of cancer) in 4 hospitals within the Mayo Clinic Health System. MAIN OUTCOME MEASURES: Patient characteristics, endoscopic location and size, and preoperative and operative polyp pathology were tabulated. Correlations between these features and the finding of invasive carcinoma on surgical pathology were assessed. RESULTS: A total of 750 patients met our inclusion criteria. Patients were predominantly male (55.2%) with an average age of 69.4 ± 9.8 years. A majority of polyps were located in the right colon (70.9%). Invasive cancer was identified in 133 patients (17.7%). Multivariate analysis revealed polyps in the left colon (adjusted OR 2.13, 95% CI (1.22-3.72)), and those with high-grade dysplasia (adjusted OR 4.60, 95% CI (2.91-7.27)) were more likely to harbor carcinoma. Age, sex, polyp dimension, and villous features were not predictive of malignancy. Of the patients with cancer, 31 (23.3%) had nodal disease. LIMITATIONS: This study is limited by its retrospective nature, the change in terminology and technique over time, and the partially subjective nature of an endoscopically unresectable polyp. CONCLUSIONS: The finding that polyp size and villous features do not strongly predict malignancy differs from previous endoscopic studies. This study confirms that polyps located in the left colon or with high-grade dysplasia are more likely to harbor cancer. The results of this study suggest that endoscopically unresectable polyps are best treated by radical oncologic resection.

Original languageEnglish (US)
Pages (from-to)1111-1116
Number of pages6
JournalDiseases of the Colon and Rectum
Volume55
Issue number11
DOIs
StatePublished - Nov 2012

Fingerprint

Colectomy
Polyps
Neoplasms
Colon
Colonic Polyps
Carcinoma
Surgical Pathology
Colonoscopy
Terminology
Colorectal Neoplasms
Multivariate Analysis
Pathology

Keywords

  • Colectomy
  • Endoscopically unresectable
  • Polyps

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Bertelson, N. L., Kalkbrenner, K. A., Merchea, A., Dozois, E., Landmann, R. G., De Petris, G., ... Etzioni, D. A. (2012). Colectomy for endoscopically unresectable polyps: How often is it cancer. Diseases of the Colon and Rectum, 55(11), 1111-1116. https://doi.org/10.1097/DCR.0b013e3182695115

Colectomy for endoscopically unresectable polyps : How often is it cancer. / Bertelson, Noelle L.; Kalkbrenner, Kristen A.; Merchea, Amit; Dozois, Eric; Landmann, Ron G.; De Petris, Giovanni; Young-Fadok, Tonia M.; Etzioni, David A.

In: Diseases of the Colon and Rectum, Vol. 55, No. 11, 11.2012, p. 1111-1116.

Research output: Contribution to journalArticle

Bertelson, NL, Kalkbrenner, KA, Merchea, A, Dozois, E, Landmann, RG, De Petris, G, Young-Fadok, TM & Etzioni, DA 2012, 'Colectomy for endoscopically unresectable polyps: How often is it cancer', Diseases of the Colon and Rectum, vol. 55, no. 11, pp. 1111-1116. https://doi.org/10.1097/DCR.0b013e3182695115
Bertelson, Noelle L. ; Kalkbrenner, Kristen A. ; Merchea, Amit ; Dozois, Eric ; Landmann, Ron G. ; De Petris, Giovanni ; Young-Fadok, Tonia M. ; Etzioni, David A. / Colectomy for endoscopically unresectable polyps : How often is it cancer. In: Diseases of the Colon and Rectum. 2012 ; Vol. 55, No. 11. pp. 1111-1116.
@article{63f7012fc212468d9a960a176d56170a,
title = "Colectomy for endoscopically unresectable polyps: How often is it cancer",
abstract = "BACKGROUND: Colonoscopy has an established role in reducing the burden of colorectal cancer through early detection and removal of polyps. For endoscopically unresectable polyps, colectomy is generally indicated to prevent malignant transformation or to remove cancer already present. OBJECTIVE: This study aimed to determine the incidence of malignancy and the factors predictive of malignancy in surgically resected benign polyps. DESIGN/PATIENTS/SETTING: This study was a retrospective chart review of patients undergoing a colectomy for a colonic polyp (no preoperative diagnosis of cancer) in 4 hospitals within the Mayo Clinic Health System. MAIN OUTCOME MEASURES: Patient characteristics, endoscopic location and size, and preoperative and operative polyp pathology were tabulated. Correlations between these features and the finding of invasive carcinoma on surgical pathology were assessed. RESULTS: A total of 750 patients met our inclusion criteria. Patients were predominantly male (55.2{\%}) with an average age of 69.4 ± 9.8 years. A majority of polyps were located in the right colon (70.9{\%}). Invasive cancer was identified in 133 patients (17.7{\%}). Multivariate analysis revealed polyps in the left colon (adjusted OR 2.13, 95{\%} CI (1.22-3.72)), and those with high-grade dysplasia (adjusted OR 4.60, 95{\%} CI (2.91-7.27)) were more likely to harbor carcinoma. Age, sex, polyp dimension, and villous features were not predictive of malignancy. Of the patients with cancer, 31 (23.3{\%}) had nodal disease. LIMITATIONS: This study is limited by its retrospective nature, the change in terminology and technique over time, and the partially subjective nature of an endoscopically unresectable polyp. CONCLUSIONS: The finding that polyp size and villous features do not strongly predict malignancy differs from previous endoscopic studies. This study confirms that polyps located in the left colon or with high-grade dysplasia are more likely to harbor cancer. The results of this study suggest that endoscopically unresectable polyps are best treated by radical oncologic resection.",
keywords = "Colectomy, Endoscopically unresectable, Polyps",
author = "Bertelson, {Noelle L.} and Kalkbrenner, {Kristen A.} and Amit Merchea and Eric Dozois and Landmann, {Ron G.} and {De Petris}, Giovanni and Young-Fadok, {Tonia M.} and Etzioni, {David A.}",
year = "2012",
month = "11",
doi = "10.1097/DCR.0b013e3182695115",
language = "English (US)",
volume = "55",
pages = "1111--1116",
journal = "Diseases of the Colon and Rectum",
issn = "0012-3706",
publisher = "Lippincott Williams and Wilkins",
number = "11",

}

TY - JOUR

T1 - Colectomy for endoscopically unresectable polyps

T2 - How often is it cancer

AU - Bertelson, Noelle L.

AU - Kalkbrenner, Kristen A.

AU - Merchea, Amit

AU - Dozois, Eric

AU - Landmann, Ron G.

AU - De Petris, Giovanni

AU - Young-Fadok, Tonia M.

AU - Etzioni, David A.

PY - 2012/11

Y1 - 2012/11

N2 - BACKGROUND: Colonoscopy has an established role in reducing the burden of colorectal cancer through early detection and removal of polyps. For endoscopically unresectable polyps, colectomy is generally indicated to prevent malignant transformation or to remove cancer already present. OBJECTIVE: This study aimed to determine the incidence of malignancy and the factors predictive of malignancy in surgically resected benign polyps. DESIGN/PATIENTS/SETTING: This study was a retrospective chart review of patients undergoing a colectomy for a colonic polyp (no preoperative diagnosis of cancer) in 4 hospitals within the Mayo Clinic Health System. MAIN OUTCOME MEASURES: Patient characteristics, endoscopic location and size, and preoperative and operative polyp pathology were tabulated. Correlations between these features and the finding of invasive carcinoma on surgical pathology were assessed. RESULTS: A total of 750 patients met our inclusion criteria. Patients were predominantly male (55.2%) with an average age of 69.4 ± 9.8 years. A majority of polyps were located in the right colon (70.9%). Invasive cancer was identified in 133 patients (17.7%). Multivariate analysis revealed polyps in the left colon (adjusted OR 2.13, 95% CI (1.22-3.72)), and those with high-grade dysplasia (adjusted OR 4.60, 95% CI (2.91-7.27)) were more likely to harbor carcinoma. Age, sex, polyp dimension, and villous features were not predictive of malignancy. Of the patients with cancer, 31 (23.3%) had nodal disease. LIMITATIONS: This study is limited by its retrospective nature, the change in terminology and technique over time, and the partially subjective nature of an endoscopically unresectable polyp. CONCLUSIONS: The finding that polyp size and villous features do not strongly predict malignancy differs from previous endoscopic studies. This study confirms that polyps located in the left colon or with high-grade dysplasia are more likely to harbor cancer. The results of this study suggest that endoscopically unresectable polyps are best treated by radical oncologic resection.

AB - BACKGROUND: Colonoscopy has an established role in reducing the burden of colorectal cancer through early detection and removal of polyps. For endoscopically unresectable polyps, colectomy is generally indicated to prevent malignant transformation or to remove cancer already present. OBJECTIVE: This study aimed to determine the incidence of malignancy and the factors predictive of malignancy in surgically resected benign polyps. DESIGN/PATIENTS/SETTING: This study was a retrospective chart review of patients undergoing a colectomy for a colonic polyp (no preoperative diagnosis of cancer) in 4 hospitals within the Mayo Clinic Health System. MAIN OUTCOME MEASURES: Patient characteristics, endoscopic location and size, and preoperative and operative polyp pathology were tabulated. Correlations between these features and the finding of invasive carcinoma on surgical pathology were assessed. RESULTS: A total of 750 patients met our inclusion criteria. Patients were predominantly male (55.2%) with an average age of 69.4 ± 9.8 years. A majority of polyps were located in the right colon (70.9%). Invasive cancer was identified in 133 patients (17.7%). Multivariate analysis revealed polyps in the left colon (adjusted OR 2.13, 95% CI (1.22-3.72)), and those with high-grade dysplasia (adjusted OR 4.60, 95% CI (2.91-7.27)) were more likely to harbor carcinoma. Age, sex, polyp dimension, and villous features were not predictive of malignancy. Of the patients with cancer, 31 (23.3%) had nodal disease. LIMITATIONS: This study is limited by its retrospective nature, the change in terminology and technique over time, and the partially subjective nature of an endoscopically unresectable polyp. CONCLUSIONS: The finding that polyp size and villous features do not strongly predict malignancy differs from previous endoscopic studies. This study confirms that polyps located in the left colon or with high-grade dysplasia are more likely to harbor cancer. The results of this study suggest that endoscopically unresectable polyps are best treated by radical oncologic resection.

KW - Colectomy

KW - Endoscopically unresectable

KW - Polyps

UR - http://www.scopus.com/inward/record.url?scp=84868518679&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84868518679&partnerID=8YFLogxK

U2 - 10.1097/DCR.0b013e3182695115

DO - 10.1097/DCR.0b013e3182695115

M3 - Article

C2 - 23044670

AN - SCOPUS:84868518679

VL - 55

SP - 1111

EP - 1116

JO - Diseases of the Colon and Rectum

JF - Diseases of the Colon and Rectum

SN - 0012-3706

IS - 11

ER -