Prevalence of Endoscopically Curable Low-Risk Cancer Among Large (≥20 mm) Nonpedunculated Polyps in the Right Colon,Clinical Gastroenterology and Hepatology

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Prevalence of Endoscopically Curable Low-Risk Cancer Among Large (≥20 mm) Nonpedunculated Polyps in the Right Colon
Clinical Gastroenterology and Hepatology ( IF 11.6 ) Pub Date : 2024-07-31 , DOI: 10.1016/j.cgh.2024.07.017
Julia L Gauci ₁ , Anthony Whitfield ₂ , Renato Medas ₃ , Clarence Kerrison ₂ , Francesco Vito Mandarino ₁ , David Gibson ₄ , Timothy O'Sullivan ₂ , Oliver Cronin ₂ , Sunil Gupta ₂ , Brian Lam ₁ , Varan Perananthan ₁ , Luke Hourigan ₅ , Simon Zanati ₄ , Rajvinder Singh ₆ , Spiro Raftopoulos ₇ , Alan Moss ₄ , Gregor Brown ₄ , Amir Klein ₈ , Lobke Desomer ₉ , David J Tate ₁₀ , Steven J Williams ₁ , Eric Y Lee ₂ , Nicholas Burgess ₂ , Michael J Bourke ₂

Affiliation

Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.
Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia; Westmead Clinical School of Medicine, University of Sydney, Sydney, Australia.
Centro Hospitalar e Universitario São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal.
Department of Gastroenterology and Hepatology, Alfred Hospital, Melbourne, Australia; Department of Gastroenterology and Hepatology, Epworth Hospital, Melbourne, Australia.
Department of Gastroenterology, Princess Alexandra Hospital (Queensland Health), Brisbane, Australia.
Department of Gastroenterology and Hepatology, Lyell McEwan Hospital, Adelaide, Australia.
Department of Gastroenterology, Sir Charles Gairdner Hospital, Perth, Australia.
Ambam Heath Care Campus, Technion Institute of Technology, Haifa, Israel; Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel.
AZ Delta Roeselare, University Hospital Ghent, Ghent, Belgium.
Department of Gastroenterology and Hepatology, University Hospital of Ghent, Ghent, Belgium; Faculty of Medicine, University of Ghent, Ghent, Belgium.

Endoscopic submucosal dissection is increasingly promoted for the treatment of all large nonpedunculated colorectal polyps (LNPCPs) to cure potential low-risk cancers (superficial submucosal invasion without additional high-risk histopathologic features). The effect of a universal en bloc strategy on oncologic outcomes for the treatment of LNPCPs in the right colon is unknown. We evaluated this in a large Western population. A prospective cohort of patients referred for endoscopic resection (ER) of LNPCPs was analyzed. Patients found to have cancer after ER and those referred directly to surgery were included. The primary outcome was to determine the proportion of right colon LNPCPs with low-risk cancer. Over 180 months until June 2023, 3294 sporadic right colon LNPCPs in 2956 patients were referred for ER at 7 sites (median size 30 [interquartile range 15] mm). A total of 63 (2.1%) patients were referred directly to surgery, and cancer was proven in 56 (88.9%). A total of 2851 (96.4%) of 2956 LNPCPs underwent ER (median size 35 [interquartile range 20] mm), of which 75 (2.6%) were cancers. The overall prevalence of cancer in the right colon was 4.4% (n = 131 of 2956). Detailed histopathologic analysis was possible in 115 (88%) of 131 cancers (71 after ER, 44 direct to surgery). After excluding missing histopathologic data, 23 (0.78%) of 2940 sporadic right colon LNPCPs were low-risk cancers. The proportion of right colon LNPCPs referred for ER containing low-risk cancer amenable to endoscopic cure was <1%, in a large, multicenter Western cohort. A universal endoscopic submucosal dissection strategy for the management of right colon LNPCPs is unlikely to yield improved patient outcomes given the minimal impact on oncologic outcomes.

更新日期：2024-07-31

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