Piecemeal snare excision of large sessile colon and rectal polyps: is it adequate?

This study analyzes 28 consecutive patients with large sessile polyps snared piecemeal from the colon and rectum. The sections were examined to determine the adequacy of orientation and margin of excision. Orientation was judged excellent in five, good in 12, fair in six, and poor in five cases. The margin of excision was judged adequate in 23 of 28 cases. Five of eight patients with invasive carcinoma underwent bowel resection, and no residual tumor was found in the resected specimens. Of the remaining 20 patients without carcinoma, five had residual tumor or recurrences, with follow-up from 6 months to 6 years (average, 18 months). All of them underwent rebiopsies and electrocoagulation. None of the residual tumor or recurrences showed evidence of malignancy. Piecemeal snare excision of large sessile polyps of the large bowel appears to be an adequate procedure for most patients. A close follow-up with colonoscopy or proctoscopy is essential because residual tumor or recurrences are common.