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Conservative management of malignant colorectal polyps in select cases is safe in long-term follow-up: An institutional review

Published:February 28, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.02.059

      Highlights

      • Little data on omitting resection for early-stage malignant colorectal polyps.
      • Patient selection critical when pursuing organ-sparing strategies.
      • Survival with non-operative management equivalent in select settings.

      Abstract

      Background

      Non-operative management of early-stage polypectomy-identified colorectal cancer (CRC) may be a safe alternative, but limited data exist.

      Methods

      We compared outcomes between adults with post-polypectomy CRC who did and did not ultimately undergo resection from 2003 to 2018. Overall (OS) and recurrence-free (RFS) survival were calculated via log rank analysis using the Mantel-Cox method and plotted on Kaplan-Meier curves with significance evaluated at P < 0.05.

      Results

      N = 78 patients were included, most commonly with rectal/rectosigmoid CRC (45%). Almost half (47%) had resections, and the remaining 41 patients (53%) underwent organ-sparing techniques. Chemoradiation was administered to 5 of these 41 patients (12%), all with rectal cancer. At median follow-up of 52 months, 5-year OS and RFS were 78% and 100% with no significant differences when compared to resection (all P > 0.1).

      Discussion

      Using evidence-based patient selection and adjuvant therapy, organ-sparing management provides equal survival when compared to resection for post-polypectomy CRC.

      Keywords

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