Oncologic Colorectal Resection, Not Advanced Endoscopic Polypectomy, Is the Best Treatment for Large Dysplastic Adenomas

Introduction: Endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), and partial circumference resection are used for large benign polyps to avoid an "Oncologic" Colorectal Resection (OCR); polyps with invasive cancer require OCR. This review of polyp patients who had OCR was done to stratify polyps into risk groups to guide treatment. Methods: Colonoscopy, operative, and pathology reports of patients with adenoma (+/- dysplasia) who had OCR were reviewed. Polyp size, location, and pathology were assessed. Results: Three hundred eighty-six polyp patients who had OCR were studied. Polyp locations were: right, 263 (68. 1%); transverse, 33 (8. 6%); sigmoid, 38 (9. 8%); rectum, 23 (6. 0%); and multiple sites, 13 (3. 4%). The preoperative diagnosis was adenoma for 288 (74. 6%) and dysplastic adenoma for 98 patients (25. 4%). Final pathology revealed 62 invasive cancers (16. 1%); 35% (34 out of 98) with dysplasia preoperatively had cancer versus 9. 7% (28 out of 288) with adenoma alone (p < 0. 0001). The mean lymph node count was 16. 0 ± 10. 2. Cancer stage breakdown was: stage 1, 74%; stage 2, 8. 1%; stage 3, 16%; and stage 4, 1. 6%. The mean benign polyp size was 3. 0 ± 1. 9 versus 3. 9 ± 2. 4 cm for malignant polyps (p = 0. 0008). Conclusion: Over one out of three of dysplastic polyps and 10% of adenomas were invasive cancers. OCR is advised for dysplastic polyps; ESD, EMR, and wedge resection are appropriate for non-dysplastic adenomas.