Colon cancer incidence in the United States is dropping, but a significant number of patients who undergo colonoscopies have large or difficult-to-remove polyps. In the past, these patients would be referred for surgical resection because the polyps would be viewed as too challenging to remove endoscopically.
Today, advanced endoscopic techniques are usually a better and safer alternative to traditional surgery, even when removing large polyps. Emre Gorgun, M.D., FACS, FASCRS, a staff surgeon in the department of colorectal surgery, Cleveland Clinic, Cleveland, Ohio, believes that many colectomy procedures (surgical removal of the colon) are performed based on subjective criteria and are not necessary. To further investigate, Dr. Gorgun performed a retrospective study to evaluate the incidence of invasive cancer in 439 patients referred for surgical resection (removal) of the colon because of large, apparently benign colon polyps.
Dr. Gorgun found that cancer was identified in only 37 patients (8 percent), meaning that 92 percent of patients did not have identifiable cancer. These results were in keeping with Dr. Gorgun’s initial hypothesis. He responded by saying, "The significant finding of this research is that only 8 percent of patients who underwent colectomy for a large, apparently benign polyp had cancer, which means that 92 percent of patients had their colon removed for noncancerous reasons."
Removing larger polyps by endoscopy has many benefits including cost benefits to health care systems, avoidance of post-surgical complications and better quality of life for patients. It is important to remember that a colon resection is a major abdominal operation and has many associated risks.
"These findings suggest that we need to transform our surgical approach to ensure we better serve each patient. In a patient with an endoscopically unresectable colorectal polyp that looks benign, a more conservative, organ-sparing approach to removing them is usually safe," Dr. Gorgun said. "Our results suggest that advanced endoscopic techniques or a laparoscopic-assisted approach should be considered if there is not high suspicion for cancer” (Source: Oncology Nurse Advisor).
