title: Endoscopic and surgical treatment of malignant colorectal polyps: a population-based comparative study.
abstract: BACKGROUND
  Long-term population-based data comparing endoscopic therapy (ET) and surgery for management of malignant colorectal polyps (MCPs) are limited.
  
  
  OBJECTIVE
  To compare colorectal cancer (CRC)-specific survival with ET and surgery.
  
  
  METHODS
  Population-based study.
  
  
  METHODS
  Patients with stage 0 and stage 1 MCPs were identified from the Surveillance Epidemiology and End Results (SEER) database (1998-2009). Demographic characteristics, tumor size, location, treatment modality, and survival were compared. Propensity-score matching and Cox proportional hazards regression models were used to evaluate the association between treatment and CRC-specific survival.
  
  
  METHODS
  ET and surgery.
  
  
  METHODS
  Mid-term (2.5 years) and long-term (5 years) CRC-free survival rates and independent predictors of CRC-specific mortality.
  
  
  RESULTS
  Of 10,403 patients with MCPs, 2688 (26%) underwent ET and 7715 (74%) underwent surgery. Patients undergoing ET were more likely to be older white men with stage 0 disease. Surgical patients had more right-sided lesions, larger MCPs, and stage 1 disease. There was no difference in the 2.5-year and 5-year CRC-free survival rates between the 2 groups in stage 0 disease. Surgical resection led to higher 2.5-year (97.8% vs 93.2%; P < .001) and 5-year (96.6% vs 89.8%; P < .001) CRC-free survival in stage 1 disease. These results were confirmed by propensity-score matching. ET was a significant predictor for CRC-specific mortality in stage 1 disease (hazard ratio 2.40; 95% confidence interval, 1.75-3.29; P < .001).
  
  
  CONCLUSIONS
  Comorbidity index not available, selection bias.
  
  
  CONCLUSIONS
  ET and surgery had comparable mid- and long-term CRC-free survival rates in stage 0 disease. Surgical resection is the recommended treatment modality for MCPs with submucosal invasion.
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA.
authors.forename: Rawad
authors.initials: R
authors.lastname: Mounzer
authors.affiliation: Arizona Center for Digestive Health, Gilbert, Arizona, USA.
authors.forename: Ananya
authors.initials: A
authors.lastname: Das
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA.
authors.forename: Roy D
authors.initials: RD
authors.lastname: Yen
authors.affiliation: University of Kansas School of Medicine and Veterans Affairs Medical Center, Kansas City, Missouri, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Rastogi
authors.affiliation: University of Kansas School of Medicine and Veterans Affairs Medical Center, Kansas City, Missouri, USA.
authors.forename: Ajay
authors.initials: A
authors.lastname: Bansal
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Hosford
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA; Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center, Denver, Colorado, USA.
authors.forename: Sachin
authors.initials: S
authors.lastname: Wani
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000628:therapy*; D000236:Adenoma / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D007417:Intestinal Polyps / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012007:Rectum / Q000601:surgery*; D018426:SEER Program; D016019:Survival Analysis; D016896:Treatment Outcome