Management of patients with polyps containing malignancy removed by colonoscopic polypectomy

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Abstract
The management of malignant colonic polyps removed colonoscopically has been a controversial subject. A continuing series is reported of 36 patients with 37 malignant polyps removed by colonoscopic polypectomy (CP) between 1976-1982. Fourteen polyps contained carcinoma in situ (CIS); 13 were treated by CP alone; 1 was treated by CP and colectomy. Nineteen polyps contained invasive carcinoma; 13 were treated by CP alone; 6 were treated by CP and colectomy. Four patients had sessile polyps resected piecemeal, in which accurate staging was impossible. Two were treated with CP alone; 2 had CP plus colectomy. All patients were followed with yearly colonoscopy and/or Ba enema. Follow-up has been 6-84 mo. (mean 36 mo.). Patients (27) whose polyps were treated by CP alone have had no evidence of recurrent tumor at the polypectomy site. Of the 9 patients undergoing colectomy, 6 had residual tumor at the polypectomy resection site. No patients had involved lymph nodes. Our current approach to this problem is based on the degree of invasion and the status of the resection margins. Polyps containing CIS can safely be treated with CP alone. Polyps with invasive carcinoma and clear resection margins should be treated with CP and either colectomy of frequent repeat colonoscopy. This decision is a clinical one and must involve input from both the clinician and the pathologist. Those polyps whose resection margins are involved or where piecemeal excision precludes accurate pathologic assessment should undergo colectomy.