title: Scope or scalpel? A matched study of the treatment of large colorectal polyps.
abstract: BACKGROUND
  Large colorectal polyps can be treated either endoscopically or by formal resection. The aim of this study was to clarify the relative advantages and disadvantages of surgical resection and colonoscopic snaring as means of treating large colorectal polyps.
  
  
  METHODS
  This is a matched cohort study, comparing cases of surgical resection of benign colorectal polyps with endoscopic resection. Cases drawn from pathology and endoscopy databases were matched for the size and site of polyps, and the groups were compared for the end points of complications, length of hospital stay and completeness of the removal of the polyp.
  
  
  RESULTS
  There were 78 patients in each group, with mean ages of 65.6 years (colonoscopy) and 66.8 years (surgery). A total of 39 of the surgery group and 47 of the colonoscopy group were men. Mean polyp size was 34.1 mm (colonoscopy) and 32.1 mm (surgery). There was an exact match for polyp location. Complications occurred in eight colonoscopy patients (10.3%) and 42 surgery patients (56.0%) (P < 0.001, chi-square). Length of hospital stay was 0 days for colonoscopy patients and 7.3 ± 4.7 days for surgery (P < 0.001). The surgery group was separated into laparoscopic (n = 35) and open (n = 43) surgery. There was no difference in complication rates (42.4 versus 53.5%, respectively) but laparoscopic had shorter length of stay (5.8 days ± 4.9 SD versus 8.4 days ± 4.3 SD). Recurrence of surgically resected polyps was zero; at last follow-up 13% of snared polyps persisted.
  
  
  CONCLUSIONS
  Although resection is a more certain and absolute way of treating benign polyps, endoscopic polypectomy is preferable.
authors.affiliation: Department of Colorectal Surgery, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: James
authors.initials: J
authors.lastname: Church
authors.affiliation: Department of Colorectal Surgery, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Arman
authors.initials: A
authors.lastname: Erkan
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D001707:Biopsy, Needle; D016022:Case-Control Studies; D003082:Colectomy / Q000295:instrumentation / Q000379:methods*; D003111:Colonic Polyps / Q000473:pathology / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D016208:Databases, Factual; D000069916:Endoscopic Mucosal Resection / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D061646:Operative Time; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: colonoscopy; colorectal polyps; polypectomy; surgical resection