title: The management of malignant polyps in colorectal cancer screening programmes: A retrospective Italian multi-centre study.
abstract: BACKGROUND
  Although recognition of colorectal malignant polyps is increasing, treatment plans lack the evidence of randomised trials.
  
  
  OBJECTIVE
  To retrospectively evaluate presentation, management and outcomes of screen-detected colorectal malignant polyps, with special focus on the role of histological factors in therapeutic decision-making.
  
  
  METHODS
  We retrospectively analysed data regarding malignant polyps detected during faecal immuno-chemical test-based screening programmes in five centres in North-Eastern Italy between April 2008 and April 2013.
  
  
  RESULTS
  306 malignant polyps in 306 patients were included; 72 patients underwent surgery directly (23.6%). Of 234 patients treated endoscopically, 133 subsequently underwent radicalisation surgery (56.8%) and in 17 there was evidence of residual disease (12.8%). Involved, unsafe (<1mm) or invaluable resection margins and sessile morphology represented the most frequent determinants of subsequent surgery. The mean number of nodes harvested during radicalisation surgery was 7.1±6.4 (range 0-29). Histological diagnosis was re-evaluated according to new guidelines in 125 cases (41%); in 18 this led to modification of the risk class (14.4%).
  
  
  CONCLUSIONS
  Although the rate of surgical treatment following endoscopic resection is similar to other studies, residual disease at surgery was lower than most international series. Adhering to the new histological reporting system and respecting guidelines on node harvesting may favourably influence prognosis.
authors.affiliation: Provincial Department of Gastroenterology and Digestive Endoscopy, Santa Chiara Hospital, Trento, Italy. Electronic address: renato.fasoli@libero.it.
authors.forename: Renato
authors.initials: R
authors.lastname: Fasoli
authors.affiliation: Provincial Department of Gastroenterology and Digestive Endoscopy, Santa Chiara Hospital, Trento, Italy.
authors.forename: Richard
authors.initials: R
authors.lastname: Nienstedt
authors.affiliation: Histo-pathology Unit, Santa Chiara Hospital, Trento, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: De Carli
authors.affiliation: Gastroenterology and Digestive Endoscopy Unit, Bassano del Grappa Hospital, Bassano del Grappa, VI, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Monica
authors.affiliation: Gastroenterology and Digestive Endoscopy Unit, Sant'Antonio Hospital, Padova, Italy.
authors.forename: Ennio
authors.initials: E
authors.lastname: Guido
authors.affiliation: Gastroenterology and Digestive Endoscopy Unit, Santa Maria del Prato Hospital, Feltre, BL, Italy.
authors.forename: Flavio
authors.initials: F
authors.lastname: Valiante
authors.affiliation: Provincial Department of Gastroenterology and Digestive Endoscopy, Santa Chiara Hospital, Trento, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Armelao
authors.affiliation: Provincial Department of Gastroenterology and Digestive Endoscopy, Santa Chiara Hospital, Trento, Italy; Provincial Department of Gastroenterology and Digestive Endoscopy, Santa Maria del Carmine Hospital, Rovereto, TN, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Pretis
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000473:pathology* / Q000556:secondary / Q000601:surgery*; D003111:Colonic Polyps / Q000473:pathology* / Q000601:surgery*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D003657:Decision Making; D055088:Early Detection of Cancer; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007558:Italy; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D018365:Neoplasm, Residual; D009780:Occult Blood; D017410:Practice Guidelines as Topic; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D047368:Tumor Burden
keywords: Colorectal cancer screening; Colorectal malignant polyps; Histological re-evaluation; Radicalisation surgery