Jayasankar Balaji, Balasubramaniam Dinesh, Abdelsaid Kirolos, Frowde Kyle, Galloway Emily, Hassan Mohamed
Colorectal Surgery, Belfast Health and Social Care Trust, Belfast, GBR.
General Surgery, Maidstone and Tunbridge Wells NHS (National Health Service) Trust, Maidstone, GBR.
Cureus. 2023 Apr 23;15(4):e38027. doi: 10.7759/cureus.38027. eCollection 2023 Apr.
Introduction Colonoscopic polypectomy is a well-established screening and surveillance modality for malignant colorectal polyps. Following the detection of a malignant polyp, patients are either put on endoscopic surveillance or planned for a surgical procedure. We studied the outcome of colonoscopic excision of malignant polyps and their recurrence rates. Methods We performed a retrospective analysis over a period of five years (2015-2019) of patients who underwent colonoscopy and resection of malignant polyps. Size of polyp, follow-up with tumour markers, CT scan, and biopsy were considered individually for pedunculate and sessile polyps. We analysed the percentage of patients who underwent surgical resection, the percentage of patients who were managed conservatively, and the percentage of recurrence post-excision of malignant polyps. Results A total of 44 patients were included in the study. Of the 44 malignant polyps, most were present in the sigmoid colon at 43% (n=19), with the rectum containing 41% (n=18). The ascending colon accounted for 4.5% (n=2), transverse colonic polyps were 7% (n=3), and the descending colon polyps were 4.5% (n=2). Pedunculated polyps made up 55% (n=24). These were Level 1-3 based on Haggits classification; 14 were Haggits Level 1, eight were Haggits Level 2, and two were Haggits Level 3. The rest were sessile polyps making up 45% (n=20). Based on the Kikuchi classification, these were predominantly SM1 (n=12) and SM2 (n=8). Out of 44 cases, 11% (n=5) underwent surgical resection on follow-up in the form of bowel resection. This included three right hemicolectomies, one sigmoid colectomy, and one low anterior resection. Seven per cent (n=3) underwent endoscopic resection as trans-anal endoscopic mucosal resection (TEMS) and 82% (n=36) of the remaining cases were managed with regular follow-up and surveillance. Conclusions Colonoscopic polypectomy offers excellent benefits in detecting colorectal cancer and treating pre-malignant polyps. Colonoscopic polypectomy provides excellent benefits in colorectal cancer (CRC) detection and treatment of malignant polyps. However, it remains to be seen if post-polypectomy surveillance for low-risk polyp cancers would require a change in surveillance.
引言
结肠镜下息肉切除术是一种成熟的用于筛查和监测恶性大肠息肉的方法。在检测到恶性息肉后，患者要么接受内镜监测，要么计划进行外科手术。我们研究了结肠镜下切除恶性息肉的结果及其复发率。
方法
我们对2015年至2019年期间接受结肠镜检查并切除恶性息肉的患者进行了为期五年的回顾性分析。对于有蒂息肉和无蒂息肉，分别考虑息肉大小、肿瘤标志物随访、CT扫描和活检情况。我们分析了接受手术切除的患者百分比、保守治疗的患者百分比以及恶性息肉切除后的复发百分比。
结果
共有44例患者纳入本研究。在44个恶性息肉中，大多数位于乙状结肠，占43%（n = 19），直肠占41%（n = 18）。升结肠占4.5%（n = 2），横结肠息肉占7%（n = 3），降结肠息肉占4.5%（n = 2）。有蒂息肉占55%（n = 24）。根据哈吉茨分类，这些息肉为1 - 3级；14个为哈吉茨1级，8个为哈吉茨2级，2个为哈吉茨3级。其余为无蒂息肉，占45%（n = 20）。根据菊池分类，这些息肉主要为SM1（n = 12）和SM2（n = 8）。在这44例病例中，11%（n = 5）在随访中接受了肠切除形式的手术切除。这包括3例右半结肠切除术、1例乙状结肠切除术和1例低位前切除术。7%（n = 3）接受了经肛门内镜黏膜切除术（TEMS）形式的内镜切除，其余82%（n = 36）的病例通过定期随访和监测进行管理。
结论
结肠镜下息肉切除术在检测结直肠癌和治疗癌前息肉方面具有显著益处。结肠镜下息肉切除术在结直肠癌（CRC）检测和恶性息肉治疗方面具有显著益处。然而，对于低风险息肉癌的息肉切除术后监测是否需要改变仍有待观察。
