Endoscopic removal of large sessile
polyps is sometimes technically difficult and is associated with an increased risk of complications. Moreover, the incidence of invasive
carcinoma within these
polyps is not negligible. Laparoscopic colorectal resection has been recommended in the treatment of these large
polyps. This study aimed to evaluate the outcomes of laparoscopic colorectal resection for
polyps that were not suitable for colonoscopic removal.
METHODS: Forty-five patients (28 men and 17 women) who underwent laparoscopic colorectal resection with the preoperative diagnosis of colorectal
polyps were analyzed. The reasons for surgical resection were large sessile
polyps (n = 34), difficult position (n = 2), recurrence after transanal endoscopic microsurgery (n = 1), and the presence of intramucosal
malignancy on histology after colonoscopic polypectomy (n = 8).
RESULTS: The mean age of the patients was 66.7 years (range, 33-89). Previous abdominal operation had been performed in 12 patients (26.7%). Two patients underwent subtotal
colectomy because of multiple
polyps (14 and 19, respectively). Synchronous resection of other organs was performed in two patients (a right
salpingo-oophorectomy and a right
adrenalectomy).
Intraoperative complications occurred in two patients, and two patients (4.5%) required conversion because of perforation of the colon during dissection and dense adhesions, respectively. There was no postoperative mortality. Complications occurred in seven patients (15.6%), and they included postoperative
ileus (n = 4),
anastomotic leakage (n = 1),
urinary retention (n = 1), and
urinary tract infection (n = 1). Reoperation was required in one patient for
anastomotic leakage. The median
hospital stay was 6 days. The histopathology of colorectal
polyps showed tubular (n = 12), tubulovillous (n = 13), and
villous adenoma (n = 12); mixed adenomatous/hyperolastic
polyps (n = 2); inflammatory
polyp (n = 1); and colonic
lipoma (n = 1). Four patients, who had previous polypectoray with intramucosal
malignancy, had no residual pathology. The median size was 3.0 cm. Invasive
carcinoma was found in 16 patients (35.6%). The median number of lymph node sampling was six, and two patients had
lymph node metastases.
CONCLUSIONS:
Colonic polyps that were not amendable for colonoscopic removal were associated with a high incidence of malignant invasion. Laparoscopic
colectomy offers safe and effective management of these
polyps with the benefits of early postoperative recovery.