Combined laparoscopic-endoscopic resections of colorectal polyps: 10-year experience and follow-up.
BACKGROUND
Large, colorectal polyps or those that are difficult to access may be unamenable to conventional snare polypectomy and may require surgical resection. This study was designed to evaluate the resection of such lesions by the use of combined laparoscopic-endoscopic resections (CLER).


METHODS
Patients who had received CLER for colorectal polyps between January 1997 and December 2006 were identified from a prospectively maintained database. Patients with biopsies consistent with invasive cancer were excluded from the combined approach. Baseline characteristics, surgical, pathological, postoperative, and follow-up data of patients and lesions were reviewed.


RESULTS
A total of 146 consecutive patients underwent CLER for 154 lesions, and 120 (82%) patients underwent local excision (i.e., laparoscopy-assisted endoscopic resection, endoscopy-assisted wedge resection, and endoscopy-assisted transluminal resection). Twenty-six (18%) patients received endoscopy-assisted segmental colon resection. Conversion rate was 5% and intraoperative complications occurred in two patients (1%). Major postoperative complications occurred in five patients (3%), necessitating surgical reintervention in four of them. Follow-up colonoscopy revealed metachronous adenomas in 33 patients, of which 8 patients showed macroscopic or microscopic characteristics of advanced lesions. One patient, who had been converted to open resection because of incomplete laparoscopic resection of an adenoma, developed relapse of the initial adenoma and was successfully treated with repeat CLER accounting for a local recurrence rate of 0.9%.


CONCLUSIONS
Combined laparoscopic-endoscopic resection is an efficient, safe, and minimally invasive alternative to open resection for selected patients with difficult polyps, but it should be restricted to benign disease.
Wilhelm
Dirk
D
Working Group for Minimally Invasive Therapy and Intervention, Technische Universität München, Klinikum rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germany.
von Delius
Stefan
S
Weber
Lars
L
Meining
Alexander
A
Schneider
Armin
A
Friess
Helmut
H
Schmid
Roland M
RM
Frimberger
Eckart
E
Feussner
Hubertus
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D003111:Colonic Polyps / Q000473:pathology / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome