Long-term outcomes after endoscopic removal of malignant colorectal polyps: results from a 10-year cohort

Aims 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 follow-up were investigated. Event rates for categorical and means for continuous variables with 95% confidence intervals were calculated; 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 135 lesions (mean size: 22.1 mm, main location: 42% rectal) of 129 patients (mean age: 67.7 years; 56% male) were enrolled. Proportion of pedunculated and non-pedunculated lesions was similar, with en bloc resection in 82% and 47%, respectively. Tumor differentiation, distance from resection margins, depth of submucosal invasion, lympho-vascular invasion and budding was adequately reported in 89.6%, 45.2%, 58.5%, 31.9%, and 25.2%, respectively. Residual tumor was found in 10, and nodal metastasis in 4 out of 41 patients who underwent secondary surgical resection. Univariate analysis identified piece meal resection as risk factor for residual malignancy (OR 1.74, p=0.042).

At least 1-year follow-up was available for 117 lesions of 111 patients (mean follow-up period: 5.59 years). 54%, 30%, 30%, 11%, and 16% of patients presented at 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 and 9 patients, respectively), with no difference between patients undergoing secondary surgery and surveillance-only.

Conclusions Reporting of histologic 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 or not.

Publication History

Article published online:
15 April 2024