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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Apr 16, 2024; 16(4): 193-205
Published online Apr 16, 2024. doi: 10.4253/wjge.v16.i4.193
Long-term outcomes after endoscopic removal of malignant colorectal polyps: Results from a 10-year cohort
Anna Fábián, Renáta Bor, Béla Vasas, Mónika Szűcs, Tibor Tóth, Zsófia Bősze, Kata Judit Szántó, Péter Bacsur, Anita Bálint, Bernadett Farkas, Klaudia Farkas, Ágnes Milassin, Mariann Rutka, Tamás Resál, Tamás Molnár, Zoltán Szepes
Anna Fábián, Renáta Bor, Tibor Tóth, Zsófia Bősze, Kata Judit Szántó, Péter Bacsur, Anita Bálint, Bernadett Farkas, Klaudia Farkas, Ágnes Milassin, Mariann Rutka, Tamás Resál, Tamás Molnár, Zoltán Szepes, Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
Béla Vasas, Department of Pathology, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
Mónika Szűcs, Department of Medical Physics and Medical Informatics, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6720, Hungary
Klaudia Farkas, USZ Translational Colorectal Research Group, Hungarian Centre of Excellence for Molecular Medicine, Szeged 6725, Hungary
Author contributions: Fábián A, Bor R, and Szepes Z designed the study; Tóth T, Bősze Zs, Szántó K, Bacsur P, Bálint A, Farkas B, Farkas K, Milassin Á, Rutka M, and Resál T collected and analyzed the data; Vasas B provided pathological revision of histological samples; Fábián A, and Szűcs M performed the statistical analysis; Fábián A drafted the manuscript; Bor R, Vasas B, Bősze Zs, Molnár T, and Szepes Z provided critical revision; All authors read and approved the final manuscript.
Supported by the New National Excellence Program of the Ministry for Innovation and Technology From the Source of the National Research, Development and Innovation Fund, No. ÚNKP-22-4-SZTE-296, No. ÚNKP-23-3-SZTE-268, and No. ÚNKP-23-5-SZTE-719; and the EU’s Horizon 2020 Research and Innovation Program under Grant Agreement, No. 739593.
Institutional review board statement: This study was carried out in accordance with the Helsinki Declaration and was approved by the Regional and Institutional Human Medical Biological Research Ethics Committee of University of Szeged (Clinical Trial Registration Number: 4137/2018).
Informed consent statement: As this was a retrospective cohort study, consent from patients was unnecessary.
Conflict-of-interest statement: All authors have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Anna Fábián, MD, PhD, Assistant Lecturer, Attending Doctor, Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Kálvária sgt. 57, Szeged 6725, Hungary. fabiananna9@gmail.com
Received: November 29, 2023
Peer-review started: November 29, 2023
First decision: December 27, 2023
Revised: January 28, 2024
Accepted: March 18, 2024
Article in press: March 18, 2024
Published online: April 16, 2024
BACKGROUND
Choosing an optimal post-polypectomy management strategy of malignant colorectal polyps is challenging, and evidence regarding a surveillance-only strategy is limited.
AIM
To evaluate long-term outcomes after endoscopic removal of malignant colorectal polyps.
METHODS
A single-center retrospective cohort study was conducted to evaluate outcomes after endoscopic removal of malignant colorectal polyps between 2010 and 2020. Residual disease rate and nodal metastases after secondary surgery and local and distant recurrence rate for those with at least 1 year of follow-up were investigated. Event rates for categorical variables and means for continuous variables with 95% confidence intervals were calculated, and Fisher’s exact test and Mann-Whitney test were performed. Potential risk factors of adverse outcomes were determined with univariate and multivariate logistic regression models.
RESULTS
In total, 135 lesions (mean size: 22.1 mm; location: 42% rectal) from 129 patients (mean age: 67.7 years; 56% male) were enrolled. The proportion of pedunculated and non-pedunculated lesions was similar, with en bloc resection in 82% and 47% of lesions, respectively. Tumor differentiation, distance from resection margins, depth of submucosal invasion, lymphovascular invasion, and budding were reported at 89.6%, 45.2%, 58.5%, 31.9%, and 25.2%, respectively. Residual tumor was found in 10 patients, and nodal metastasis was found in 4 of 41 patients who underwent secondary surgical resection. Univariate analysis identified piecemeal resection as a risk factor for residual malignancy (odds ratio: 1.74; P = 0.042). At least 1 year of follow-up was available for 117 lesions from 111 patients (mean follow-up period: 5.59 years). Overall, 54%, 30%, 30%, 11%, and 16% of patients presented at the 1-year, 3-year, 5-year, 7-year, and 9-10-year surveillance examinations. Adverse outcomes occurred in 9.0% (local recurrence and dissemination in 4 patients and 9 patients, respectively), with no difference between patients undergoing secondary surgery and surveillance only.
CONCLUSION
Reporting of histological features and adherence to surveillance colonoscopy needs improvement. Long-term adverse outcome rates might be higher than previously reported, irrespective of whether secondary surgery was performed.
Core Tip: Despite recent advancements in endoscopy and the ability to perform optical diagnoses, submucosal invasion in colorectal polyps is often diagnosed at post-polypectomy histological evaluations. The reporting of high-risk histological features cannot serve as the sole basis of optimal post-polypectomy management strategy. Long-term adverse outcomes after endoscopic resection of malignant colorectal polyps might be more common than previously reported, irrespective of whether secondary surgery was performed. Therefore, adherence to post-polypectomy surveillance colonoscopy should be improved.
