Management of the Endoscopically Removed Malignant Polyp

ABSTRACT

Colonoscopy and polypectomy are being performed in increasing numbers. Pathologic review of the polyps occasionally demonstrates the presence of invasive carcinoma. This challenges the clinician to determine whether to recommend observation and colonoscopic follow-up or a surgical resection to the patient. Management of this peculiar condition is based on an understanding of colorectal carcinoma, colonic anatomy, and endoscopy. Specific principles of polyp evaluation include complete endoscopic excision, proper histologic orientation, and pathologic evaluation of the polyp (assessment of tumor grade and margin of excision). Retrospective studies have evaluated many of these features. Until additional studies of tumor biology are available, previous studies suggest that polyps that have been completely excised with clear margins along with the absence of poor differentiation and lymphovascular invasion can be observed and followed with colonoscopy. Patients with polyps that do not meet these criteria who are acceptable surgical risks should undergo surgical resection. Adherence to these recommendations has produced excellent long-term survival and minimized unnecessary surgical resections.

KEYWORDS

Polyp - malignant - carcinoma - endoscopy - polypectomy

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