SURGICAL MANAGEMENT OF ENDOSCOPICALLY UNRESECTABLE COLORECTAL POLYPS

pasin, ozge; Kunduz, Enver; BALIK, Emre; Ilhan, Burak; uymaz, derya salim

doi:10.26650/IUITFD.1115321

SURGICAL MANAGEMENT OF ENDOSCOPICALLY UNRESECTABLE COLORECTAL POLYPS

Burak ILHAN, (Istanbul University, Istanbul Faculty of Medicine, Department of General Surgery, Istanbul, Turkiye)

Enver KUNDUZ, (Bezmialem University, Faculty of Medicine, Department of General Surgery, Istanbul, Turkiye)

Derya SALİM UYMAZ, (Koç University, Faculty of Medicine, Department of General Surgery, Istanbul, Turkiye)

Emre BALIK, (Koç University, Faculty of Medicine, Department of General Surgery, Istanbul, Turkiye)

Özge PASİN (Bezmialem University, Faculty of Medicine, Department of Biostatistics, Istanbul, Turkiye)

İstanbul Tıp Fakültesi Dergisi

3 2

Yıl: 2023 Cilt: 86 Sayı: 2 Sayfa Aralığı: 130 - 137 Metin Dili: İngilizce DOI: 10.26650/IUITFD.1115321 İndeks Tarihi: 10-05-2023

SURGICAL MANAGEMENT OF ENDOSCOPICALLY UNRESECTABLE COLORECTAL POLYPS

Öz:

Objective: To define the management of colorectal polyps that were technically unsuitable for endoscopic removal. Materials and Methods: Between May 2010 and January 2019, 4886 polyps from 3822 of 16,996 colorectal endoscopies were analyzed. Of the total colorectal polyps, 135 (2.8%) were identified as endoscopically unresectable single polyps and examined in detail. Result: The rate of invasive colorectal cancer (CRC) in unresectable and resectable polyps was 26.7% and 1.7%, respectively (p<0.001). Unresectable polyps were more common in the ascending colon and cecum (p<0.001), but the potential to contain invasive CRC was greater in the sigmoid colon and rectum-located polyps (p=0.001). In addition, advancing age (p=0.014), increased polyp size (p=0.012), deep submucosal invasion (p<0.001), and the presence of lymphovascular invasion (p<0.001) were associated with the development of CRC. Unresectable polyps requiring surgery after non-curative endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) were found to have a significantly higher risk of containing CRC compared with polyps that underwent surgical resection primarily (p=0.002). In the multivariate model, advancing age (p=0.010) and detected deep submucosal invasion (p=0.002) were more associated with the development of CRC. Conclusion: The study suggests that oncologic surgery for polyps with deep submucosal invasion (particularly by EMR or ESD) that cannot be endoscopically resected in older patients should be considered carefully and, perhaps, without delay, primarily by abandoning repeated endoscopic resection attempts.

Anahtar Kelime:

ENDOSKOPİK OLARAK ÇIKARILAMAYAN KOLOREKTAL POLİPLERE CERRAHİ YAKLAŞIM

Öz:

Amaç: Bu çalışma, endoskopik olarak çıkarılması teknik olarak uygun olmayan kolorektal poliplerin tedavisini tanımlamayı amaçladı. Gereç ve Yöntem: Mayıs 2010 ile Ocak 2019 tarihleri arasında 16,996 kolorektal endoskopiden 3,822’sinde 4,886 polip analiz edildi. Total kolorektal poliplerin 135’i (%2,8) endoskopik olarak çıkarılamayan tekli polip olarak tanımlandı ve detaylı olarak incelendi. Bulgular: Rezeke edilemeyen bir polipte invaziv kolorektal kanser (KRK) oranı %26,7 iken, rezeke edilebilir bir polipte bu oran %1,7 idi (p<0,001). Rezeke edilemeyen polipler çıkan kolon ve çekumda daha yaygındı (p<0,001), ancak invaziv KRK içerme potansiyeli sigmoid kolon ve rektum yerleşimli poliplerde daha fazlaydı (p=0,001). Ayrıca ilerleyen yaş (p=0,014), artmış polip boyutu (p=0,012), derin submukozal invazyon (p<0,001) ve lenfovasküler invazyon varlığı (p<0,001) KRK gelişimi ile ilişkiliydi. Küratif olmayan endoskopik mukozal rezeksiyon (EMR) veya endoskopik submukozal diseksiyon (ESD) sonrası ameliyat gerektiren rezeke edilemeyen poliplerin, primer olarak cerrahi rezeksiyon uygulanan poliplere kıyasla anlamlı derecede daha yüksek KRK içerme riskine sahip olduğu bulundu (p=0,002). Çok değişkenli modelde ilerleyen yaş (p=0,010) ve saptanan derin submukozal invazyon (p=0,002) KRK gelişimi ile daha fazla ilişkiliydi. Sonuç: Çalışma, yaşlı hastalarda endoskopik olarak rezeke edilemeyen derin submukozal invazyonlu (özellikle EMR veya ESD ile) polipler için onkolojik cerrahinin dikkatli bir şekilde düşünülmesi gerektiğini ve belki de gecikmeden, öncelikle tekrarlanan endoskopik rezeksiyon girişimlerinden vazgeçilmesi gerektiğini önermektedir.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

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APA	Ilhan B, Kunduz E, uymaz d, BALIK E, pasin o (2023). SURGICAL MANAGEMENT OF ENDOSCOPICALLY UNRESECTABLE COLORECTAL POLYPS. , 130 - 137. 10.26650/IUITFD.1115321
Chicago	Ilhan Burak,Kunduz Enver,uymaz derya salim,BALIK Emre,pasin ozge SURGICAL MANAGEMENT OF ENDOSCOPICALLY UNRESECTABLE COLORECTAL POLYPS. (2023): 130 - 137. 10.26650/IUITFD.1115321
MLA	Ilhan Burak,Kunduz Enver,uymaz derya salim,BALIK Emre,pasin ozge SURGICAL MANAGEMENT OF ENDOSCOPICALLY UNRESECTABLE COLORECTAL POLYPS. , 2023, ss.130 - 137. 10.26650/IUITFD.1115321
AMA	Ilhan B,Kunduz E,uymaz d,BALIK E,pasin o SURGICAL MANAGEMENT OF ENDOSCOPICALLY UNRESECTABLE COLORECTAL POLYPS. . 2023; 130 - 137. 10.26650/IUITFD.1115321
Vancouver	Ilhan B,Kunduz E,uymaz d,BALIK E,pasin o SURGICAL MANAGEMENT OF ENDOSCOPICALLY UNRESECTABLE COLORECTAL POLYPS. . 2023; 130 - 137. 10.26650/IUITFD.1115321
IEEE	Ilhan B,Kunduz E,uymaz d,BALIK E,pasin o "SURGICAL MANAGEMENT OF ENDOSCOPICALLY UNRESECTABLE COLORECTAL POLYPS." , ss.130 - 137, 2023. 10.26650/IUITFD.1115321
ISNAD	Ilhan, Burak vd. "SURGICAL MANAGEMENT OF ENDOSCOPICALLY UNRESECTABLE COLORECTAL POLYPS". (2023), 130-137. https://doi.org/10.26650/IUITFD.1115321

APA	Ilhan B, Kunduz E, uymaz d, BALIK E, pasin o (2023). SURGICAL MANAGEMENT OF ENDOSCOPICALLY UNRESECTABLE COLORECTAL POLYPS. İstanbul Tıp Fakültesi Dergisi, 86(2), 130 - 137. 10.26650/IUITFD.1115321
Chicago	Ilhan Burak,Kunduz Enver,uymaz derya salim,BALIK Emre,pasin ozge SURGICAL MANAGEMENT OF ENDOSCOPICALLY UNRESECTABLE COLORECTAL POLYPS. İstanbul Tıp Fakültesi Dergisi 86, no.2 (2023): 130 - 137. 10.26650/IUITFD.1115321
MLA	Ilhan Burak,Kunduz Enver,uymaz derya salim,BALIK Emre,pasin ozge SURGICAL MANAGEMENT OF ENDOSCOPICALLY UNRESECTABLE COLORECTAL POLYPS. İstanbul Tıp Fakültesi Dergisi, vol.86, no.2, 2023, ss.130 - 137. 10.26650/IUITFD.1115321
AMA	Ilhan B,Kunduz E,uymaz d,BALIK E,pasin o SURGICAL MANAGEMENT OF ENDOSCOPICALLY UNRESECTABLE COLORECTAL POLYPS. İstanbul Tıp Fakültesi Dergisi. 2023; 86(2): 130 - 137. 10.26650/IUITFD.1115321
Vancouver	Ilhan B,Kunduz E,uymaz d,BALIK E,pasin o SURGICAL MANAGEMENT OF ENDOSCOPICALLY UNRESECTABLE COLORECTAL POLYPS. İstanbul Tıp Fakültesi Dergisi. 2023; 86(2): 130 - 137. 10.26650/IUITFD.1115321
IEEE	Ilhan B,Kunduz E,uymaz d,BALIK E,pasin o "SURGICAL MANAGEMENT OF ENDOSCOPICALLY UNRESECTABLE COLORECTAL POLYPS." İstanbul Tıp Fakültesi Dergisi, 86, ss.130 - 137, 2023. 10.26650/IUITFD.1115321
ISNAD	Ilhan, Burak vd. "SURGICAL MANAGEMENT OF ENDOSCOPICALLY UNRESECTABLE COLORECTAL POLYPS". İstanbul Tıp Fakültesi Dergisi 86/2 (2023), 130-137. https://doi.org/10.26650/IUITFD.1115321