Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2019; 7(20): 3217-3225
Published online Oct 26, 2019. doi: 10.12998/wjcc.v7.i20.3217
Clinical characteristics of sentinel polyps and their correlation with proximal colon cancer: A retrospective observational study
Man Wang, Jia-Jie Lu, Wen-Jie Kong, Xiao-Jing Kang, Feng Gao
Man Wang, Jia-Jie Lu, Wen-Jie Kong, Feng Gao, Department of Gastroenterology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, Xinjiang Uygur Autonomous Region, China
Xiao-Jing Kang, Department of Dermatology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, Xinjiang Uygur Autonomous Region, China
Author contributions: Wang M and Gao F designed the study; Wang M acquired the data and drafted the article; Lu JJ and Kong WJ analyzed and interpreted the data; Kang XJ revised the article critically for important intellectual content. All the authors approved the version to be published.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the People’s Hospital of Xinjiang Uygur Autonomous Region.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Data sharing statement: The protocol for this study is available in Chinese Clinical Trial Registry (ChiCTR1900021639). The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.
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 which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Feng Gao, PhD, Chairman, Department of Gastroenterology, People’s Hospital of Xinjiang Uygur Autonomous Region, No. 91, Tianchi Road, Tianshan District, Urumqi 830001, Xinjiang Uygur Autonomous Region, China. drxjgf@sina.com
Telephone: +86-991-8564761 Fax: +86-991-8564761
Received: April 11, 2019
Peer-review started: April 12, 2019
First decision: August 1, 2019
Revised: August 23, 2019
Accepted: September 11, 2019
Article in press: September 11, 2019
Published online: October 26, 2019
Processing time: 198 Days and 12.5 Hours
Abstract
BACKGROUND

Colorectal cancer is a common malignant tumor of the digestive tract. The relationship between sentinel polyps (rectal polyps with proximal colon cancer) and proximal colon cancer has received extensive attention in recent years. However, there is still no clear conclusion regarding the relationship.

AIM

To investigate the clinical characteristics of sentinel polyps and their correlation with proximal colon cancer.

METHODS

A retrospective analysis of 2587 patients with rectal polyps from January 2006 to December 2017 was performed. According to whether or not proximal colon cancer was diagnosed, the patients were divided into either a sentinel polyp group (192 patients) or a pure rectal polyp group (2395 patients). The endoscopic features, clinicopathological features, therapeutic effects, and short-term prognosis were analyzed and compared between the two groups.

RESULTS

The mean age of patients in the sentinel polyp group was generally higher than that of the pure rectal polyp group, and the positivity rates of anemia, stool occult blood, and tumor markers of the sentinel polyp group were also significantly higher than those in the rectal polyp group (χ2 = 90.56, P < 0.01; χ2 = 70.30, P < 0.01; χ2 = 92.80, P < 0.01). The majority of the patients in the sentinel polyp group had multiple polyps, large polyps, adenomatous polyps, or sessile polyps (χ2 = 195.96, P < 0.01; χ2 = 460.46, P < 0.01; χ2 = 94.69, P < 0.01; χ2 = 48.01, P < 0.01). Most of the proximal colon cancers were Duke’s A and B stages in the sentinel polyp group. In the pure rectal polyp group, 2203 patients underwent endoscopic treatment, and all of the patients were cured and discharged. In the sentinel polyp group, 65 patients underwent radical operation, and 61 patients received endoscopic submucosal dissection or endoscopic mucosal resection. Additionally, 21 patients were lost to follow-up after 6-12 mo, and the loss rate was 10.94%. A total of 63.16% of patients experienced remission without tumor recurrence or metastasis, 33.33% of patients experienced tumors regression or improved symptoms, and the other 3.51% of the patients died.

CONCLUSION

If there are multiple, sessile, and adenomatous rectal polyps with a maximum diameter > 1 cm, the possibility of the carcinogenesis of the polyps or of the proximal colon should be monitored closely. These patients should be followed in the short-term and should undergo a whole-colon examination.

Keywords: Sentinel polyps; Rectal polyps; Proximal colon cancer; Ascending colon cancer; Transverse colon cancer

Core Tip: This retrospective study included 2587 patients with rectal polyps. According to whether or not proximal colon cancer was diagnosed, the patients were divided into either a sentinel polyp group or a pure rectal polyp group. The endoscopic features, clinicopathological features, therapeutic effects, and short-term prognosis were analyzed. We found that if there were multiple, sessile, and adenomatous rectal polyps with a maximum diameter > 1 cm, the risk of the carcinogenesis of the polyps or of proximal colon cancer is high, and a full colonoscopy and follow-up should be performed.