The conservative follow-up of patients with an irradical resected colorectal malignant polyp.

Smeets, X. (Xavier) (2014) The conservative follow-up of patients with an irradical resected colorectal malignant polyp. thesis, Medicine.

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Abstract

Background For pathologists, it is difficult to assess the oncological radicality of endoscopically removed malignant polyps. If radicality is not certain, surgical resection is recommended. However, in 85% of cases, the resected specimen does not contain residual disease, while surgery carries with it considerable morbidity and mortality. Therefore, a conservative approach is practiced in the Deventer Hospital. The purpose of this research was the identification of patients with a potentially irradical resected malignant polyp who didn’t receive surgery and to assess the occurrence of tumour recurrence and tumour-free survival, as well as factors associated with them. Methods Retrospective single-centre study to assess the percentage of recurrence and disease course in patients with a potentially irradical resected malignant polyp who didn’t receive surgery. A prerequisite for a conservative approach was tumour-free biopsies from the polypectomy scar. Patients were selected by using the nationwide pathology registration system. Multiple searches were run to obtain an inclusion as complete as possible. All hits (n=410) were verified by hand. Information regarding disease course were taken from a patient’s medical records and their general practitioner. Results 38 patients met the inclusion criteria. The endoscopic removal of the malignant polyp took place between 1999 and 2011. Within a median follow-up of 46 months, seven patients (18.4%) had a recurrence. Six of them could be treatedsurgically. One patient was diagnosed with liver metastases after four years. This patient did not have regular radiological follow-up. All patients who received regular radiology (CT scan) and endoscopic surveillance could be treated with curative intent. Conclusions In accordance with the literature, 82% of the patients with a histologically potentially irradical, but endoscopically radical resected malignant polyp had no recurrence. Provided that patients received careful follow-up including radiology (6 patients), the recurrences were still operable with curative intent. One patient presented with incurable disease and did not receive regular radiological follow-up. These results suggest that in some cases, a conservative approach can be practiced safely. These results justify a prospective trial as well.

Item Type:	Thesis (Thesis)
Supervisor name:	Borg, Dr. F. ter and Gastroenterology, Deventer Hospital
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:43
Last Modified:	25 Jun 2020 10:43
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/509

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