title: Combined endoscopic and laparoscopic surgery may be an alternative to bowel resection for the management of colon polyps not removable by standard colonoscopy.
abstract: BACKGROUND
  Benign colon polyps may require bowel resection if endoscopic polypectomy cannot be performed to assess adequately for cancer. However, endoscopic removal still may be possible using combined endoscopic and laparoscopic surgery (CELS). The CELS procedure allows for intra- and extraluminal manipulation of the bowel wall to facilitate polyp removal, thereby avoiding bowel resection. This study evaluated the authors' institutional experience with CELS in this patient population.
  
  
  METHODS
  Between August 2008 and October 2012, all patients referred to undergo surgery for a benign colon polyp were retrospectively reviewed for operative characteristics, pathology, and postoperative outcomes. Of 14 patients, five were considered candidates for CELS and were compared with nine patients who underwent resection.
  
  
  RESULTS
  The average patient age was similar between the two groups (CELS, 64.9 years vs. resection, 68.3 years). The mean polyp size was 2.3 cm in the CELS group and 2.9 cm in the resection group. In the CELS group, polyps were successfully removed in all cases. The mean operating room time was 159 min in the CELS group and 205 min in the resection group. The median hospital stay was 1 day in the CELS group and 5 days in the resection group. No complications occurred in the CELS group. Two patients in the resection group (22 %) experienced a wound infection. One patient had a postoperative ileus (11 %). Four patients in the CELS group had a benign adenoma. One patient had a benign frozen section evaluation, but the final pathology showed adenocarcinoma requiring a subsequent colectomy. In the resection group, six patients had a benign adenoma, and three patients had a T1N0 cancer. In the CELS group, repeat endoscopy was performed an average of 9.9 months after CELS. Two patients had a residual polyp, and two patients had new polyps in a different location. All were successfully removed.
  
  
  CONCLUSIONS
  For benign-appearing polyps not amenable to endoscopic techniques alone, CELS may be an alternative to formal bowel resection for carefully selected patients. The CELS procedure can be performed safely with minimal morbidity and with outcomes that compare favorably with those of formal colectomy.
authors.affiliation: Department of Surgery, David Geffen School of Medicine, University of California at Los Angeles, 10833 LeConte Avenue, 72-253 CHS, Los Angeles, CA 90095, USA.
authors.forename: Minna K
authors.initials: MK
authors.lastname: Lee
authors.forename: Formosa
authors.initials: F
authors.lastname: Chen
authors.forename: Eric
authors.initials: E
authors.lastname: Esrailian
authors.forename: Marcia McGory
authors.initials: MM
authors.lastname: Russell
authors.forename: Jonathan
authors.initials: J
authors.lastname: Sack
authors.forename: Anne Y
authors.initials: AY
authors.lastname: Lin
authors.forename: James
authors.initials: J
authors.lastname: Yoo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003111:Colonic Polyps / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods*; D003131:Combined Modality Therapy; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies