title: Oncological outcomes after endoscopic removal of malignant colorectal polyps.
abstract: OBJECTIVE
  malignant colorectal polyp, defined by submucosally invasive adenocarcinoma, is the earliest form of clinically relevant colorectal cancer (CRC). After endoscopic resection additional surgery may be necessary, although decision criteria remain debatable. The objective of this study was to assess oncologic outcomes in terms of locoregional disease and to identify areas of improvement that may facilitate patients' management.
  
  
  METHODS
  retrospective study of 40 patients with T1 CRC endoscopically resected between 2007 and 2012. Clinicopathological features were assessed and correlated with residual disease (RD), defined as presence of adenocarcinoma in intestinal wall and/ or lymph nodes.
  
  
  RESULTS
  thirty-one patients underwent surgery while 9 were followed-up. After surgery, RD was confirmed in 15 (48.4%) patients: 8 (53.3%) wall disease, 5 (33%) nodal metastasis, and 2 (13.3%) with both. No recurrence was detected in the follow-up group. The characteristics of the lesions that were associated with DR were sessile configuration (p = 0.03), the degree of differentiation G3 (p = 0.01) and intercepted/indeterminate margins (p = 0.01). Twenty-two patients were operated because of inadequate evaluation, mainly due to piecemeal resection, and half of them were disease free. Postoperative complications were found in 9 (30%) patients, mainly anastomotic leakage that was associated with rectum anterior resection (p = 0.03).
  
  
  CONCLUSIONS
  surgery should be considered in the presence of any risk factor for residual disease, while follow-up can be offered in low risk settings. Was also demonstrated a clear need for technical improvement in endoscopic resection and pathology evaluation in order to prevent unnecessary surgeries.
authors.forename: Bruno Moreira
authors.initials: BM
authors.lastname: Gonçalves
authors.forename: Vasco
authors.initials: V
authors.lastname: Fontainhas
authors.forename: Ana Célia
authors.initials: AC
authors.lastname: Caetano
authors.forename: Aníbal
authors.initials: A
authors.lastname: Ferreira
authors.forename: Raquel
authors.initials: R
authors.lastname: Gonçalves
authors.forename: Pedro
authors.initials: P
authors.lastname: Bastos
authors.forename: Carla
authors.initials: C
authors.lastname: Rolanda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000601:surgery*; D003111:Colonic Polyps / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011127:Polyps / Q000601:surgery*; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome