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Laparoscopic colon resection of benign polyps: high grade dysplasia on endoscopic biopsy and polyp location predict risk of cancer.

Abstract

BACKGROUND
To ensure that an oncologic resection is not compromised, laparoscopic surgery is not recommended for colon cancer patients during the learning curve. Although patients with colon polyps are frequently selected as "learning cases," several studies have found a high incidence of occult cancers in this subset of patients questioning the safety of this approach. A retrospective review was performed of laparoscopic resections for colonic polyps to determine the incidence of occult cancer and, clinical and pathologic factors predictive of cancer.
METHODS AND RESULTS
From January 2004 and September 2007, 44 colectomies were performed for colonic polyps. Data from a prospective database was examined and supplemented by pathology reports. Of 44 patients, operative conversion was 5% with a 4-day median length of stay, a morbidity of 20% with no mortalities. All patients had clear surgical margins with a median of 12 lymph nodes detected. An occult cancer was detected in 6 of 44 cases (14%). High-grade dysplasia on endoscopic biopsy and polyp location distal to the splenic flexure was associated with a significantly (P<0.05) increased risk of cancer. Forty-three percent of cancers were detected in polyps with high-grade dysplasia compared with 8% of polyps without dysplasia on biopsy. Polyps distal to the splenic flexure had a 43% rate of occult cancers detected compared with 8% in polyps proximal to the splenic flexure.
CONCLUSIONS
Colonic polyps with high-grade dysplasia on endoscopic biopsy and polyps located distal to the splenic flexure are associated with the highest risk of cancer and may not be appropriate cases during the learning curve.

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  • Publisher Full Text
  • Authors

    Blumberg D

    Source

    Surgical laparoscopy, endoscopy & percutaneous techniques 19:3 2009 Jun pg 255-7

    MeSH

    Aged
    Biopsy
    Colectomy
    Colonic Neoplasms
    Colonic Polyps
    Colonoscopy
    Disease Progression
    Female
    Follow-Up Studies
    Humans
    Incidence
    Laparoscopy
    Male
    Predictive Value of Tests
    Prognosis
    Retrospective Studies
    Risk Factors
    United States

    Pub Type(s)

    Comparative Study
    Journal Article

    Language

    eng

    PubMed ID

    19542857