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PubMed2000

[Laparoscopic treatment of colorectal polyps].

UNLABELLED: Endoscopic removal is the treatment of choice for colorectal polyps. However, this therapeutic option is limited by the size of the tumor, sessile implantation, or technical impossibility. These cases are ideal for laparoscopic treatment because of the anatomy of the colon is and because the risk of manipulating a malignant lesion is lower. However, there is the added difficulty of identifying the lesion. In other cases, unsuspected neoplastic invasion of an endoscopically removed polyp makes surgery necessary. AIM: To evaluate the results of laparoscopic surgery in the treatment of colorectal polyps. MATERIAL AND METHODS: Between December 1997 and November 1999, 270 endoscopic polypectomies were performed. In 15 patients, endoscopic removal was technically impossible or contraindicated. These patients were treated laparoscopically. One patient who was found to have an invasive carcinoma following polypectomy was also treated laparoscopically. The technical characteristics of the operation (duration, conversion, morbi-mortality, postoperative stay, size of the polyp and number of ganglions) were analyzed and compared with 43 other laparoscopic operations in the colon carried out for other reasons (n = 43). RESULTS: In nine patients, surgery was indicated because of the size of the polyp, in three for technical reasons, in three for severe atypia and in one because of an invasive carcinoma following polypectomy. The operation was completed by laparoscopy in 15 patients (94%). Ten right hemicolectomies, five sigmoidectomies and one anterior resection assisted by hand port were carried out. The diameter of the lesions was 4.4 +/- 2.4 cm. Histological studies revealed carcinoma in situ in five, infiltrating carcinoma in two, non-malignant adenoma in six and lipoma in one. Comparison of the results of patients who underwent colectomy for polyps with those of the group who underwent surgery for other reasons revealed lower morbidity (24% vs. 22%) and need for conversion (7% vs. 16%), as well as a significant decrease in operating time (130 +/- 10 vs. 148 +/- 32 min, p < 0.05) and in postoperative stay (6.6 +/- 1.4 vs. 8.3 +/- 2.5 days, p < 0.02). CONCLUSION: Laparoscopic colonic resection is particularly suitable in the treatment of colorectal polyps.

Adult↗
PubMedDate not supplied

Laparoscopic colectomy in the management of large, sessile, transformed colorectal polyps.

BACKGROUND: Colonic polyps are usually removed endoscopically. Surgical intervention is reserved for large, inaccessible colorectal polyps that have underdone malignant transformation. Laparoscopic management of colonic polyps has gained a well-defined role. METHODS: Since 1993, 650 laparoscopic colectomies have been performed in our department. Twenty-eight patients with large, sessile, polyps that have undergone malignant transformation underwent elective laparoscopic colectomy. Operative procedures included 14 sigmoidectomies, 10 low anterior recto-sigmoid resections, 3 right colectomies, and 1 left colectomy. Central ligation of vessels and lymph node dissection were preformed in all patients. RESULTS: The main outcome measures include conversion rate (11%), morbidity (11%), and mortality (3.5%). The mean return of bowel function was 3.1 days, liquid intake 1.4 days, solid food intake 2.5 days, and mean hospital stay 8 days. The mean specimen length was 23 cm, and the mean number of retrieved lymph nodes was 15. Malignancy according to Dukes classification was in situ, n=4; A, n=15; B, n=4; C, n=4; and D, n=1. During follow-up, 2 patients developed liver metastases. CONCLUSION: Laparoscopic colectomy is a technically feasible and effective method for treating large colorectal polyps that have undergone malignant transformation.

Aged↗
PubMed1991

[Anatomopathological aspects of colorectal polyps in Cameroon].

In order to present the main types of colo-rectal polyps in Cameroon, we reviewed all those cases received and examined in our Pathology laboratories during a six and a half year period (1st January 1984-30th June 1990). The polyps were sent by gastro-enterologists after resection during total colonoscopy, with information about age and sex of patients, signs and symptoms and sites and number of polyps. One hundred and two colorectal polyps were taken from 88 patients with a maximum of two polyps per patient. Out of these 102 polyps, we noted: 55 juvenile polyps (54%), 23 hyperplastic polyps (22.5%), 13 adenomatous polyps (12.5%), 10 inflammatory polyps (10%) and one polyp of the Peutz-Jeghers type. One case of hyperplastic polyposis and one of familial polyposis with adenomas on histological examination were registered. On the whole, juvenile polyps predominated and adenomas which can become carcinomas were less frequent than what is seen in Western developed countries. This may be due to the fact that the polyps we examined were only taken only from patients seen in outpatient department for gastrointestinal complaints.

Adolescent↗
PubMed1986

Colorectal polyps: an endoscopic experience.

Between April 1975 and December 1985, 870 colonoscopies were performed and 803 colorectal polyps were managed endoscopically. Thirty-nine per cent of the polyps were metaplastic polyps. The majority (59%) of polyps less than 5 mm in diameter were metaplastic polyps. Of the adenomatous polyps 63% were tubular, 32% were tubulovillous and 5% were villous histologically. Sixty-two per cent of all polyps were found in either the sigmoid colon or rectum. There was a higher proportion of tubulovillous adenomata (32%) than reported previously. Twenty-two patients had polypoid carcinomata and eight were removed endoscopically; four were subsequently referred for surgical excision because of 'incomplete' removal but no residual tumour was found. Fifty-three per cent of patients examined had more than one polyp. Fourteen of 19 patients who presented with a single polyp were found to have further polyps when examined subsequently and 29 of 39 patients with multiple index polyps had more polyps at follow-up. Perforation occurred in three patients, and two patients required blood transfusion following endoscopic polypectomy. It is suggested that total colonoscopy should be undertaken in all patients with polypoid disease because of the distribution of polyps found. It is further suggested that the findings of this study may be related to the high incidence of colorectal carcinoma in New Zealand.

Colon↗
PubMed1987

Expression of LewisX and sialylated LewisX antigens in human colorectal polyps.

The LewisX (LeX) antigen [characterized by trisaccharide Gal beta 1----4 (Fuc alpha 1----3)N-acetylglucosamine] is an oncodevelopmental antigen in the human colon. Monoclonal antibodies (MoAbs), anti-SSEA-1 and AH8-183, which recognize LeX antigen either on short oligosaccharide side chains or as a terminal immunodeterminant on longer carbohydrate side chains of glycoconjugates, bind to most colon cancer tissues but also to some normal colon mucosae. However, the monoclonal antibodies FH1, FH4, FH6, and IB9, which recognize extended difucosylated and trifucosylated LeX structures or their sialylated derivatives, are more cancer-associated because they rarely bind to normal colon mucosa. In the present study, these MoAbs were used to compare the expression of various LeX-related antigens in premalignant (adenomatous) and nonpremalignant (hyperplastic) colorectal polyps. Antigen expression in polyps was also compared to antigen expressions of normal colon mucosa and colon cancer tissues. The four MoAbs recognizing extended LeX antigens bound to adenomatous polyps (APs) significantly more than to hyperplastic polyps (HPs). In contrast, anti-SSEA-1 and AH8-183 recognizing monofucosyl LeX were less able to distinguish between APs and HPs. In APs, staining with the four MoAbs recognizing extended LeX antigens correlated with the premalignant parameters of larger polyp size, more severe dysplasia, and increased villose component. However, staining with AH8-183 correlated only with polyp size, and anti-SSEA-1 correlated only with polyp size and degree of dysplasia. In general, the staining frequency of HPs was similar to that of normal colon mucosa, although FH6, which did not stain any specimens of normal mucosa, stained a few HPs. The staining frequency of APs was less than that of colon cancer tissues, but these differences were generally not statistically significant. In conclusion, extended LeX antigens and their sialylated derivatives are cancer-associated antigens that are expressed preferentially in premalignant colon polyps, that tend to correlate with malignant potential in these polyps, and that may eventually help to define mechanisms involved in the polyp-to-cancer sequence.

Antibodies, Monoclonal↗