title: Dynamic article: long-term outcomes of patients undergoing combined endolaparoscopic surgery for benign colon polyps.
abstract: BACKGROUND
  Patients with large benign colon polyps not amenable to endoscopic removal commonly undergo resections. Polyp removal using combined endolaparoscopic surgery may be an effective alternative to bowel resection in select patients.
  
  
  OBJECTIVE
  The aim of this study was to evaluate short-term and long-term outcomes of patients who underwent endolaparoscopy at our institution.
  
  
  METHODS
  Medical records and a prospectively maintained database were reviewed.
  
  
  METHODS
  This study constituted a retrospective review of consecutive patients who underwent endolaparoscopy for benign polyps from 2003 to 2012.
  
  
  METHODS
  Combined endolaparoscopic surgery was performed.
  
  
  METHODS
  The primary outcomes measured were success rate, rate of recurrence, rate of malignancy, length of stay, and complication rate.
  
  
  RESULTS
  A total of 75 patients were taken to the operating room with the intention of endolaparoscopy. The most common indications were large polyp size and difficult location. Based on intraoperative findings, 10 patients were suspected of having cancer and underwent immediate laparoscopic colectomy. Of 65 attempted cases, 48 patients (74%) underwent successful combined endolaparoscopic surgery. Median follow-up time was 65 (8-87) months. Patients in whom combined endolaparoscopic surgery was unsuccessful were converted to colectomy (2 open, 15 laparoscopic). Two patients were converted because of concerns of cancer and 15 because of technical difficulties. Median operative time for successful endolaparoscopy was 145 (50-249) minutes. The complication rate was 4.4% (2/48). Median length of stay was 1 (0-6) day for endolaparoscopy vs 5 (3-19) days for those converted to colectomy. Median polyp size was 3 (1.0-7.0) cm. One patient was found to have cancer on final pathology, but refused to have further surgery. Sensitivity and specificity of predicting malignancy based on clinical findings were 33% (4/12) and 98.5% (64/65). Four of 5 patients who had recurrence (10%) after endolaparoscopy had complete endoscopic polypectomy. One patient required delayed laparoscopic colectomy for a second recurrence.
  
  
  CONCLUSIONS
  This study was limited by its retrospective nature.
  
  
  CONCLUSIONS
  Combined endolaparoscopic surgery appears to be a safe and effective alternative to colectomy in all parts of the colon in patients who have benign polyps not removable with colonoscopy alone.
authors.affiliation: New York Presbyterian Hospital, Weill-Cornell Medical College, New York, New York, USA. sal2013@med.cornell.edu
authors.forename: Sang W
authors.initials: SW
authors.lastname: Lee
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Garrett
authors.forename: Joong H
authors.initials: JH
authors.lastname: Shin
authors.forename: Koiana
authors.initials: K
authors.lastname: Trencheva
authors.forename: Toyooki
authors.initials: T
authors.lastname: Sonoda
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Milsom
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods*; D003111:Colonic Polyps / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome