For the management of endoscopically irretrievable polyps, several minimally invasive procedures are currently available as alternatives to conventional laparotomy.
However, the high rate of malignant transformation despite initially benign histology continues to be a problem.
Dr Frank Benedix and colleagues from Germany conducted a prospective multicenter observational study of all patients with adenomatous polyps unsuitable for endoscopic removal and with benign histology.
In addition to an analysis of the perioperative course and the definitive histology, the overall and disease-free survival rates of patients with malignant transformation of colorectal adenomas were also calculated.
The researchers assessed a total of 525 patients who underwent a laparoscopic resection.
|The perioperative morbidity rate was 21%|
Conversion to laparotomy became necessary in 3% of cases.
The perioperative morbidity rate was 21%, and malignant transformation occurred in a total of 18% of the adenomatous polyps.
The team found the median number of lymph nodes removed was 12, and lymph node metastases were seen in a total of 15% of the patients.
The researchers observed that the estimated 5-year overall and disease-free survival rates were 92% and 81%, respectively.
Dr Benedix’s team concluded, “For the management of endoscopically unresectable polyps, laparoscopic resection is currently the technique of choice.”
“In addition to the benefits of minimally invasive surgery, in the hands of an experienced surgeon it achieves results comparable with those of open surgery.”
“In view of the high rate of malignant transformation and the absence of unequivocal factors predictive of already present malignant transformation, an oncologically radical operation is essential.”
“In the elderly patient presenting with comorbidities limited resection aiming to minimize surgical trauma in potentially benign disease may be considered.”
“In such a case, however, frozen-section histology is obligatory.”