TY - JOUR
T1 - Endoscopic polypectomy for malignant polyps
T2 - Should tumor location (right versus left side) guide clinical decisions?
AU - Boatman, Sonja
AU - Mott, Sarah L.
AU - Shaukat, Aasma
AU - Melton, Genevieve B.
AU - Gaertner, Wolfgang B.
AU - Weiser, Martin
AU - Ikramuddin, Sayeed
AU - Madoff, Robert
AU - Hassan, Imran
AU - Goffredo, Paolo
N1 - Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2023/3
Y1 - 2023/3
N2 - Background: Current guidelines consider endoscopic resection appropriate treatment for malignant colon polyps with negative margins, low-grade histology, and no lymphovascular invasion. While increasing literature demonstrates a worse prognosis for advanced stage right- versus left-sided colon cancers after curative treatment, there is paucity of data regarding prognostic effect of location in patients undergoing endoscopic resection of T1 polyps. We hypothesized the more aggressive biologic behavior observed in advanced right-sided cancers would be similarly represented in malignant polyps, and this location would be associated with lower overall survival. Methods: The National Cancer Database was queried for adults with T1NxMx tumors who underwent endoscopic polypectomy (2004–2017). Patients with positive margins or without follow-up information were excluded. Results: A total of 2,337 patients met inclusion criteria; 22% had right-sided polyps. Endoscopically excised proximal tumors were more common in elderly, and those with public insurance and more comorbidities (all P <.01). Among patients with complete pathologic data, there were no statistical differences between right- and left-sided polyps with 1 cm median size, >92% without lymphovascular invasion, and 100% without tumor deposits. Univariate analysis showed 73% vs 86% 5-year overall survival for right versus left polyps (P <.01). After adjustment for available confounders, right-sided location remained significantly associated with worse overall survival (hazard ratio 1.49, 95% confidence interval 1.21–1.83). Conclusion: In this national cohort of patients with endoscopically excised malignant polyps, we identified right colon location as an independent prognostic factor associated with increased risk of mortality. Our data suggest polyp location should be taken into consideration when making clinical decisions regarding treatment and/or surveillance.
AB - Background: Current guidelines consider endoscopic resection appropriate treatment for malignant colon polyps with negative margins, low-grade histology, and no lymphovascular invasion. While increasing literature demonstrates a worse prognosis for advanced stage right- versus left-sided colon cancers after curative treatment, there is paucity of data regarding prognostic effect of location in patients undergoing endoscopic resection of T1 polyps. We hypothesized the more aggressive biologic behavior observed in advanced right-sided cancers would be similarly represented in malignant polyps, and this location would be associated with lower overall survival. Methods: The National Cancer Database was queried for adults with T1NxMx tumors who underwent endoscopic polypectomy (2004–2017). Patients with positive margins or without follow-up information were excluded. Results: A total of 2,337 patients met inclusion criteria; 22% had right-sided polyps. Endoscopically excised proximal tumors were more common in elderly, and those with public insurance and more comorbidities (all P <.01). Among patients with complete pathologic data, there were no statistical differences between right- and left-sided polyps with 1 cm median size, >92% without lymphovascular invasion, and 100% without tumor deposits. Univariate analysis showed 73% vs 86% 5-year overall survival for right versus left polyps (P <.01). After adjustment for available confounders, right-sided location remained significantly associated with worse overall survival (hazard ratio 1.49, 95% confidence interval 1.21–1.83). Conclusion: In this national cohort of patients with endoscopically excised malignant polyps, we identified right colon location as an independent prognostic factor associated with increased risk of mortality. Our data suggest polyp location should be taken into consideration when making clinical decisions regarding treatment and/or surveillance.
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U2 - 10.1016/j.surg.2022.07.041
DO - 10.1016/j.surg.2022.07.041
M3 - Article
C2 - 36266122
AN - SCOPUS:85140732860
SN - 0039-6060
VL - 173
SP - 674
EP - 680
JO - Surgery (United States)
JF - Surgery (United States)
IS - 3
ER -
