Laparoscopic colectomy for apparently benign colorectal neoplasia: A word of caution.
OBJECTIVE
Endoscopically unresectable apparently benign colorectal polyps are considered by some surgeons as ideal for their early laparoscopic colectomy experience. Our hypotheses were: (1) a substantial fraction of patients undergoing laparoscopic colectomy for apparently benign colorectal neoplasia will have adenocarcinoma on final pathology; and (2) in our practice, we perform an adequate laparoscopic oncological resection for apparently benign polyps as evidenced by margin status and nodal retrieval.


METHODS
Data from a consecutive series of patients undergoing laparoscopic colectomy (on an intention-to-treat basis) for endoscopically unresectable neoplasms with benign preoperative histology were retrieved from a prospective database and supplemented by chart review.


RESULTS
The study population consisted of 63 patients (mean age 67, mean body mass index 29). Two out of 63 cases (3%) were converted to laparotomy because of extensive adhesions (n = 1) and equipment failure (n = 1). Colectomy type: right/transverse (n = 49, 78%); left/anterior resection (n = 10, 16%); subtotal (n = 4, 6%). Invasive adenocarcinoma was found on histological analysis of the colectomy specimen in 14 out of 63 cases (22%), standard error of the proportion 0.052. Staging of the 14 cancers were I (n = 6, 43%), II (n = 3, 21%), III ( = 4, 29%), and IV (n = 1, 7%). The median nodal harvest was 12 and all resection margins were free of neoplasm. Neither dysplasia on endoscopic biopsy nor lesion diameter was predictive of adenocarcinoma. Eight out of 23 (35%) patients with dysplasia on endoscopic biopsy had adenocarcinoma on final pathology versus 6/40 (15%) with no dysplasia (p = 0.114, Fisher's exact test). Mean diameter of benign tumors was 3.2 cm (range 0.5-10.0cm) versus 3.9cm (range 1.5-7.5cm) for adenocarcinomas (p = 0.189, t - test).


CONCLUSIONS
A substantial fraction of endoscopically unresectable colorectal neoplasms with benign histology on initial biopsy will harbor invasive adenocarcinoma, some of advanced stage. This finding supports the practice of performing oncological resection for all patients with endoscopically unresectable neoplasms of the colorectum. The inexperienced laparoscopic colectomist should approach these cases with caution.
Brozovich
Marc
M
Division of Colon and Rectal Surgery, Western Pennsylvania Hospital, Clinical Campus of Temple University School of Medicine, Pittsburgh, PA 15224, USA.
Read
Thomas E
TE
Salgado
Javier
J
Akbari
Robert P
RP
McCormick
James T
JT
Caushaj
Philip F
PF
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D003082:Colectomy / Q000379:methods*; D003111:Colonic Polyps / Q000473:pathology / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male
N Engl J Med. 2004 May 13;350(20):2050-9
15141043
Am J Surg. 1999 May;177(5):384-7
10365875
Ann Surg. 1979 Dec;190(6):679-83
518167
Surg Endosc. 1998 Nov;12(11):1341-4
9788858
AORN J. 1992 Dec;56(6):1068-73
1463326
Dis Colon Rectum. 2006 Jun;49(6):879-82
16598402
Surg Endosc. 2005 Sep;19(9):1252-5
16132333
Surg Endosc. 2007 Mar;21(3):400-3
17180271
Int J Colorectal Dis. 1997;12(5):267-71
9401839
Br J Surg. 1999 Apr;86(4):505-8
10215825