Laparoscopic colon resection of benign polyps: high grade dysplasia on endoscopic biopsy and polyp location predict risk of cancer

Abstract

Background: To ensure that an oncologic resection is not compromised, laparoscopic surgery is not recommended for colon cancer patients during the learning curve. Although patients with colon polyps are frequently selected as "learning cases," several studies have found a high incidence of occult cancers in this subset of patients questioning the safety of this approach. A retrospective review was performed of laparoscopic resections for colonic polyps to determine the incidence of occult cancer and, clinical and pathologic factors predictive of cancer.

Methods and results: From January 2004 and September 2007, 44 colectomies were performed for colonic polyps. Data from a prospective database was examined and supplemented by pathology reports. Of 44 patients, operative conversion was 5% with a 4-day median length of stay, a morbidity of 20% with no mortalities. All patients had clear surgical margins with a median of 12 lymph nodes detected. An occult cancer was detected in 6 of 44 cases (14%). High-grade dysplasia on endoscopic biopsy and polyp location distal to the splenic flexure was associated with a significantly (P<0.05) increased risk of cancer. Forty-three percent of cancers were detected in polyps with high-grade dysplasia compared with 8% of polyps without dysplasia on biopsy. Polyps distal to the splenic flexure had a 43% rate of occult cancers detected compared with 8% in polyps proximal to the splenic flexure.

Conclusions: Colonic polyps with high-grade dysplasia on endoscopic biopsy and polyps located distal to the splenic flexure are associated with the highest risk of cancer and may not be appropriate cases during the learning curve.