Large
colonic polyps or
polyps that lie in anatomical locations that are difficult to access at endoscopy may not be suitable for endoscopic resection and therefore may require partial
colectomy. This approach eradicates the
polyp and allows an oncologic resection should the
polyp prove to be malignant. The purpose of this study was to assess outcomes of a laparoscopic approach for the management of these
polyps.
METHODS: Patients referred for laparoscopic
colectomy for
colonic polyps were identified from the prospective colorectal laparoscopic surgery database. Demographics, operative details, and final pathology were reviewed.
RESULTS: Fifty-one consecutive patients (27 male) with a mean age of 68 +/- 11.4 years, ASA classification (1/2/3/4) of 0/21/27/3, and body mass index (BMI) of 26.5 +/- 4.9 were identified. Right (RHC) and left (LHC)
colectomy was performed for 39 right and 12 left
colonic polyps. Mean operating time (OT) was 87 +/- 30 min (81 for RHC, 105 for LHC) and mean
hospital stay was 3.1 +/- 1.9 days. There were six complications (17.7%), including
anastomotic leak (n = 1), small bowel obstruction (n = 2),
abscess (n = 1), and exacerbation of preexisting medical conditions (n = 2). Four patients were readmitted (7.8%); one required CT scan-guided
abscess drainage (1.9%) and two required reoperation (3.9%). Five patients (9.8%) were converted because of adhesions (n = 3),
obesity (n = 1), and inability to identify the area that was tattooed at colonoscopy (n = 1). Mean
polyp size was 3.1 cm, and pathology revealed tubular (n = 14), tubulovillous (n = 33) and
villous adenoma (n = 2), pseudopolyp (n = 1), and
prolapse of the appendix into the cecum mimicking an
adenoma (n = 1). High-grade dysplasia was seen in four tubular (33%) and five tubulovillous
adenomas (15.5%).
Adenocarcinoma not identified at colonoscopy was found in 11
polyps (20%), 9 tubulovillous (27.8%) and both
villous adenomas (100%).
CONCLUSIONS: Large
colonic polyps unresectable at colonoscopy are associated with a high rate of unsuspected
cancer. This requires a formal
colectomy rather than transcolonic polypectomy. Laparoscopic
colectomy offers safe and effective management of these
polyps with the benefits of accelerated postoperative recovery.