1. Malignant colorectal polyps: endoscopic polypectomy and watchful waiting is not inferior to subsequent bowel resection. A nationwide propensity score-based analysis.
- Author
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Levic K, Bulut O, Hansen TP, Gögenur I, and Bisgaard T
- Subjects
- Adult, Aged, Cohort Studies, Colonic Polyps mortality, Colonic Polyps pathology, Colonoscopy mortality, Colorectal Neoplasms mortality, Colorectal Neoplasms pathology, Databases, Factual, Denmark, Disease-Free Survival, Female, Humans, Male, Middle Aged, Prognosis, Propensity Score, Proportional Hazards Models, Retrospective Studies, Risk Assessment, Survival Analysis, Treatment Outcome, Colectomy methods, Colonic Polyps surgery, Colonoscopy methods, Colorectal Neoplasms surgery, Watchful Waiting
- Abstract
Background and Aims: The optimal treatment of patients with malignant colorectal polyps is unsettled. The surgical dilemma following polypectomy is selecting between watchful waiting (WW) and subsequent bowel resection (SBR), but the long-term survival outcomes have not been established yet. This nationwide study compared survival of patients after WW or SBR., Methods: Danish nationwide study with 100% follow-up of all patients with malignant colorectal polyps (the Danish Colorectal Cancer Group database) in a 10-year period from 2001 to 2011. All patients' charts and histological reports were individually reviewed. Survival rates were calculated with Cox proportional hazard model after propensity score matching., Results: A total of 692 patients were included (WW, 424 (61.3%), SBR, 268 (38.7%)) with a mean follow-up of 7.5 years (3-188 months). Following propensity score matching, there was no significant difference in overall or disease-free survival (p = 0.344 and p = 0.184) or rate of local recurrence (WW, 7.2%, SBR, 2%, p = 0.052) or distant metastases (WW, 3.3%, SBR, 4.6%, p = 0.77). In the SBR group, there was no residual tumor or lymph node metastases in the resected specimen in 82.5% of the patients., Conclusion: Subsequent bowel resection may not be superior to endoscopic polypectomy and watchful waiting with regard to overall and disease-free survival in patients with malignant colorectal polyps.
- Published
- 2019
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