Surgery for Benign Colorectal Polyps
Douglas K. Rex, MD, MASGE, reviewing Saade R, et al. Endosc Int Open 2021 Apr 22.
This report from the U.S. evaluated 144 patients undergoing surgical resection for benign colorectal polyps.
There were 118 referred patients without an attempt at endoscopic removal. Of these, 22% (n=26) had a polyp <2 cm in size, 23 of which were on the right side of the colon. There were 22 patients (15%) with incomplete endoscopic resection (16 on the right side of the colon, 6 on the left side of the colon). Twelve of these had residual polyp sized <2 cm. In-hospital surgical mortality was 0.7% and morbidity was 20.1%.
COMMENTThere is currently no size-limit threshold for referral for surgical resection of benign colorectal polyps. The largest-sized benign lesions in the colorectum are the granular homogenous laterally spreading lesions. They have a very low risk of cancer, typically have minimal submucosal fibrosis, and are relatively easy to remove by endoscopic mucosal resection. The majority of surgically removed polyps in this series likely could have been resected endoscopically, including those with previous partial resections. Determining how to change the pattern of referring benign lesions for surgery rather than endoscopic resection by experts is challenging, fundamentally because we don’t understand the rationale or motivations for these referrals. Remember to educate your partners and local surgeons: no benign colorectal lesion should go to surgical resection without review by a local or regional endoscopic resection specialist.
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)
Saade R, Tsang T, Kmeid M, et al. Overutilization of surgical resection for benign colorectal polyps: analysis from a tertiary care center. Endosc Int Open 2021;9:E706-E712. (https://doi.org/10.1055/a-1380-3017)
