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Aim: The optimal management strategy for patients with endoscopically resected malignant colorectal polyps (MCP) has yet to be defined. The aim of this study was to validate a published decision‐making tool, termed the Scottish Polyp Cancer Study (SPOCS) algorithm, on a large international population. Methods: The SPOCS algorithm allocates patients to risk groups based on just two variables: the polyp resection margin and the presence of lymphovascular invasion (LVI). The risk groups are termed low (clear margin, LVI absent), medium (clear margin, LVI present) or high (involved/non‐assessable margin). The International Polyp Cancer Collaborative was formed to validate the algorithm on data from Australia, Denmark, UK and New Zealand. Results: In total, 1423 patients were included in the final dataset. 680/1423 (47.8%) underwent surgical resection and 108/680 (15.9%) had residual disease (luminal disease 8.8%, lymph node metastases 8.8%). The SPOCS algorithm classified 602 patients as low risk (in which 1.5% had residual disease), 198 patients as medium risk (in which 7.1% had residual disease) and 484 as high risk (in which 14.5% had residual disease) (P < 0.001, χ2 test). Receiver operating characteristic curve analysis demonstrated good accuracy of the algorithm in predicting residual disease (area under the curve 0.732, 95% CI 0.687–0.778, P < 0.001). When patients were designated as low risk, the negative predictive value was 98.5%. Conclusion: The SPOCS algorithm can be used to predict the risk of residual disease in patients with endoscopically resected MCPs. Surgery can be safely avoided in patients who have a clear margin of excision and no evidence of LVI. This study, a collaboration between Scotland, Australia, New Zealand and Denmark aimed to define the optimal management strategy for patients with malignant colorectal polyps. The results confirmed the SPOCS algorithm (margin & LVI) can be used to accurately predict the risk of residual disease. [ABSTRACT FROM AUTHOR]

Background: Transanal endoscopic microsurgery (TEMS) is a proven alternative therapy to either radical surgery or endoscopic mucosal resection for rectal neoplasms. It has proven benefits with lower morbidity and mortality compared with total mesorectal excision, and a lower local recurrence rate when compared to endoscopic mucosal techniques. Methods: A retrospective data collection of TEMS procedures performed through Waikato District Health Board, New Zealand, from 2010 to 2015 was conducted. Supportive follow‐up data were sourced from patient records and from local centres around New Zealand. Results: A total of 137 procedures were performed over the study period, with five being repeat procedures. Procedures were mostly performed for benign lesions (66.4%) with an overall complication rate of 15.3%, only five of which were Clavien–Dindo grade III (3.6%). Our local recurrence rate after resection of benign lesions was 5.1%. Conclusion: Our data set demonstrates the TEMS procedure to be safe compared to radical resection (total mesorectal excision) for sessile rectal lesions. Close endoscopic follow‐up is recommended, especially for close or incomplete margins. Good therapeutic results can be obtained for appropriately selected early malignant lesions. TEMS provides better oncological results than endoscopic mucosal resection or transanal excision. [ABSTRACT FROM AUTHOR]