title: Endoscopic polypectomy and management of colorectal adenomas with invasive carcinoma.
abstract: OBJECTIVE
  Invasive carcinoma is found at histology in 2-5% of colorectal polyps removed under flexible endoscopy. The aim of this study was to confirm that histologically complete endoscopic polypectomy under favorable low-risk conditions is sufficient therapy for pT1 carcinoma, while tumors at or close to the margin of the polypectomy, and histological high-risk criteria, require surgical resection with lymphadenectomy.
  
  
  METHODS
  Eighty-six patients with 87 pT1 carcinomas underwent polypectomy within a twelve-and-a-half-year period. Further treatment prospectively followed the above guidelines. The follow-up was documented.
  
  
  RESULTS
  A local tumor residue was found in 5 of 34 patients who had undergone surgical resection for doubtful or incomplete polypectomy. Two patients were found to have nodal disease in the surgical specimen, only one of them harboring a high-risk carcinoma. Two further patients with high-risk carcinomas had tumor progression, despite postpolypectomy resections without local tumor residue or lymph-node infiltration, and died. One patient had a local tumor recurrence on follow-up endoscopy eight weeks after doubtfully complete polypectomy. He underwent resection, and had no further recurrence. No further manifestations of invasive carcinoma occurred after complete polypectomy of 42 patients with low-risk carcinomas.
  
  
  CONCLUSIONS
  This study supports the view that complete endoscopic polypectomy is an adequate therapy for low-risk carcinoma: A modification of the follow-up regimen, with less frequent endoscopic controls, is justified.
authors.affiliation: Department of Medicine I, Klinikum Ludwigsburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Hackelsberger
authors.forename: P
authors.initials: P
authors.lastname: Frühmorgen
authors.forename: H
authors.initials: H
authors.lastname: Weiler
authors.forename: T
authors.initials: T
authors.lastname: Heller
authors.forename: H
authors.initials: H
authors.lastname: Seeliger
authors.forename: K
authors.initials: K
authors.lastname: Junghanns
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D017809:Fatal Outcome; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011446:Prospective Studies; D016896:Treatment Outcome