Advanced Endoscopy Techniques May Be Safe Alternative to Surgery for Most Difficult-to-Remove or Large Polyps

Advanced Endoscopy Techniques May Be Safe Alternative to Surgery for Most Difficult-to-Remove or Large Polyps
Advanced Endoscopy Techniques May Be Safe Alternative to Surgery for Most Difficult-to-Remove or Large Polyps

Most patients with large or difficult-to-remove colorectal polyps have a lower incidence of cancer than previously thought; therefore, more advanced endoscopic techniques that spare the colon may be a better and safer alternative to a traditional operation in certain cases.1

Incidence rates of colorectal cancer in the United States have decreased, largely because of screening for and removal of precancerous polyps during colonoscopy. However, a significant proportion of people who undergo colonoscopies have large polyps considered too challenging to be removed endoscopically. In such cases, these patients are referred for surgical resection.

"Currently a majority of patients undergo colon resections for large polyps that don't harbor any cancer cells, which means in many cases a person's colon is being removed for noncancerous reasons, based on subjective criteria," said Emre Gorgun, MD, FACS, FASCRS, a staff surgeon in the department of colorectal surgery, Cleveland Clinic, Cleveland, Ohio, and lead author of the study.

In this single-center, retrospective study, researchers sought to evaluate the actual incidence of invasive cancer in patients referred for surgical resection of large, apparently benign colorectal polyps. Medical records of 439 patients who underwent colectomy from 1997 to 2012 were reviewed; these patients had colorectal polyps considered too difficult for standard endoscopic treatment. None of the polyps in these patients were diagnosed as cancer prior to the surgical procedures.

In total, cancer was identified in the final pathology for just 37 patients (8%), so 92% of the patients did not have cancer identified.

"The significant finding of this research is that only 8% of patients who underwent colectomy for a large, apparently benign polyp had cancer, which means that 92% of patients had their colon removed for noncancerous reasons," Gorgun said.

"But colon resection doesn't come for free; it's a major abdominal operation associated with the risk of serious adverse events."

Nearly 20% of the patients experienced complications after colorectal procedures. Complication rates were similar between the noncancerous and cancerous groups.

Treating these types of polyps with more advanced endoscopic techniques could improve quality of life for the patients, provide cost benefit to health care systems, and avoid many complications. Experienced physicians are able to successfully treat these large, technically difficult polyps without sacrificing the colon.

"These findings suggest that we need to transform our surgical approach to ensure we better serve each patient. In a patient with an endoscopically unresectable colorectal polyp that looks benign, a more conservative, organ-sparing approach to removing them is usually safe," Gorgun said. "Our results suggest that advanced endoscopic techniques or a laparoscopic-assisted approach should be considered if there is not high suspicion for cancer."


1. Gorgun E, Benlice C, Church JM. Does cancer risk in colonic polyps unsuitable for polypectomy support the need for advanced endoscopic resections? J Am Coll Surg. 2016 Jun 30. doi: 10.1016/j.jamcollsurg.2016.05.018. [Epub ahead of print]

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