Ang Zhen Hao, Wong Shing Wai
Department of Colorectal Surgery, Prince of Wales Hospital, Sydney, NSW 2031, Australia.
Randwick Campus, School of Clinical Medicine, University of New South Wales, Sydney, NSW 2033, Australia.
Cancers (Basel). 2025 Apr 27;17(9):1464. doi: 10.3390/cancers17091464.
The aim of this review is to provide a contemporary update on the current management approaches and options with specific considerations in malignant rectal polyps.
A literature review was carried out in PubMed, Embase and Cochrane databases using the keywords "malignant" and "polyp*". Only publications in English language were included.
Histopathological features including margins, depth of invasion, tumour grade, LVI and tumour budding determines the risk of lymph node metastasis in malignant polyps. Rectal malignant polyps should be considered differently compared to their colonic counterpart. A low threshold should be considered for utilising transrectal excision to fully excise the polyp and to assess the margins. The rates of complete pathological response associated with total neoadjuvant therapy as well as the advent of "watch and wait" adds to the complexity of managing malignant rectal polyps.
The management of malignant colorectal polyps lies in risk-stratifying patients who will benefit from an oncological resection.
本综述旨在提供关于恶性直肠息肉当前管理方法和选择的当代最新信息，并给出具体考量。
在PubMed、Embase和Cochrane数据库中使用关键词“恶性”和“息肉*”进行文献综述。仅纳入英文出版物。
组织病理学特征，包括切缘、浸润深度、肿瘤分级、淋巴管浸润和肿瘤芽生，决定了恶性息肉发生淋巴结转移的风险。直肠恶性息肉与结肠恶性息肉应区别对待。对于采用经直肠切除术完全切除息肉并评估切缘，应保持较低阈值。与全新辅助治疗相关的完全病理缓解率以及“观察等待”策略的出现增加了恶性直肠息肉管理的复杂性。
恶性结直肠息肉的管理在于对将从肿瘤切除术中获益的患者进行风险分层。
