Some GI Doctors May Not Understand Significance of Intramucosal Adenocarcinoma in the Colon
Douglas K. Rex, MD, FASGE, reviewing Moon N, et al. Gastrointest Endosc 2020 Apr 22.
Several studies have found that rates of surgery for benign colorectal polyps continue to be high, despite clear evidence that endoscopic resection is safer and more cost-effective than surgical resection.
In a single-center U.S. study, 315 patients with benign colorectal polyps were referred to the colorectal surgery department; 117 of these patients were referred to the center’s interventional endoscopists for endoscopic resection. Of these, 87.2% were successfully resected endoscopically, and 5% had invasive cancer. The recurrence rate after endoscopic resection was 27%. Gastroenterologists accounted for more than two-thirds of the referrals to colorectal surgery. Predictors that patients ultimately underwent surgical resection of a benign polyp included referral by a gastroenterologist at the academic health center (odds ratio [OR], 2.52) and location of the lesion in the proximal colon (OR for distal location, 0.45). The strongest predictor was intramucosal adenocarcinoma on presurgical evaluation (OR, 5.72).
COMMENTThese data suggest that gastroenterologists are heavily involved in the continuing issue of referral of benign colorectal polyps to surgeons, although the fraction of all lesions referred by GI doctors could easily reflect the fraction of colonoscopies performed by GI doctors in the region. These data also suggest that some clinicians do not recognize that intramucosal adenocarcinoma does not meet the clinical definition of colon cancer because it lacks submucosal invasion. Lesions with this type of biopsy report are still candidates for endoscopic resection, unless there is endoscopically detected evidence of deep submucosal invasion (eg, ulceration, NICE 3, or Kudo V pits). Finally, it should be remembered that even large lesions in the cecum and right side of the colon are still candidates for endoscopic resection.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Moon N, Aryan M, Khan W, et al. The effect of referral pattern and histopathology grade on surgery for nonmalignant colorectal polyps. Gastrointest Endosc 2020 Apr 22. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2020.04.041)
