title: Avoiding colorectal resection for polyps: is CELS the best method?
abstract: BACKGROUND
  A significant proportion of colonic polyps are unsuitable for endoscopic removal. A combined endoscopic and laparoscopic approach is an alternative to conventional polypectomy or resection. In this review, we set out to determine whether avoiding segmental resection for benign colonic polyps was a viable option through combined endolaparoscopic surgery (CELS). We examined the methods and classification criteria different centers employed in their reporting. Finally, we determined whether CELS and procedures methodically similar should be considered as the standard of care today.
  
  
  METHODS
  A systematic review was performed reporting the outcomes of CELS for benign colorectal polyps. Main outcomes measured included operating time, length of hospital stay and postoperative complications. The CELS data from reports with a larger number of polyps examined were compared to data from representative EMR, ESD and laparoscopic colectomy literature.
  
  
  RESULTS
  Eighteen eligible studies with 532 patients were included. We identified three different CELS techniques: EMR, ESD and full-thickness excision. The operative time for CELS reported in 12 studies varied from 45 to 205 min. The successful endoscopic resection rate ranged from 58 to 100%. Conversion to open surgery was reported in <5%. The length of hospital stay varied from 0 to 7 days. Overall postoperative complications ranged from 0 to 18%. The reports of CELS with more than 20 polyps presented 74-91% successful rate. In comparison with laparoscopic group, CELS groups showed shorter operation time (92-145 vs 125-199 min) and length of hospital stay (1-1.5 vs 4-11 days).
  
  
  CONCLUSIONS
  CELS and similar procedures are viable options for intestinal polyps removal. Moving forward, we suggest methods to standardize CELS procedure reporting. The reported outcomes of CELS indicate that it should be seen as a viable alternative to segmental resection when endoscopic methods alone do not suffice.
authors.affiliation: Section of Colorectal Surgery, Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, 525 East 68th Street, Box 172, New York, NY, 10065, USA. knsurzx@gmail.com.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Nakajima
authors.affiliation: Section of Colorectal Surgery, Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, 525 East 68th Street, Box 172, New York, NY, 10065, USA.
authors.forename: Sameer K
authors.initials: SK
authors.lastname: Sharma
authors.affiliation: Section of Colorectal Surgery, Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, 525 East 68th Street, Box 172, New York, NY, 10065, USA.
authors.forename: Sang W
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Section of Colorectal Surgery, Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, 525 East 68th Street, Box 172, New York, NY, 10065, USA. mim2035@med.cornell.edu.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Milsom
mesh_terms: D003082:Colectomy / Q000379:methods; D003111:Colonic Polyps / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods; D003131:Combined Modality Therapy; D061887:Conversion to Open Surgery; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D061646:Operative Time; D011183:Postoperative Complications; D012189:Retrospective Studies
keywords: Colon; Endoscopy; Laparoscopy; Polypectomy; Surgery; Technique