Surgical management of malignant colorectal polyps

The anatomic landmarks of the depth of invasion for pedunculated lesions (Haggitt level) and the Sm system for the sessile lesions give excellent objective information in the management of malignant colorectal polyps. Malignant polyps with low risk of lymph node metastasis include pedunculated lesio...

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Bibliographic Details
Published inThe Surgical clinics of North America Vol. 82; no. 5; p. 959
Main Author Nivatvongs, Santhat
Format Journal Article
LanguageEnglish
Published United States 01.10.2002
Subjects
Adenoma - pathology
Adenoma - surgery
Colorectal Neoplasms - pathology
Colorectal Neoplasms - surgery
Humans
Intestinal Polyps - pathology
Intestinal Polyps - surgery
Lymphatic Metastasis
Neoplasm Invasiveness
Neoplasm Staging
Risk Factors
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Summary:The anatomic landmarks of the depth of invasion for pedunculated lesions (Haggitt level) and the Sm system for the sessile lesions give excellent objective information in the management of malignant colorectal polyps. Malignant polyps with low risk of lymph node metastasis include pedunculated lesions with invasion into Haggitt levels 1, 2, and 3. Level 4 pedunculated lesions and sessile lesions in which the invasion is into Sm1 or Sm2 level also have low risk if there are no adverse factors. These lesions can be treated by a complete local excision. Lesions that have high risk of lymph node metastasis are those with invasion into the lower third of the submucosa (Sm3), lesions that contain lymphovascular invasion, and lesions sited in the lower third of the rectum. These lesions require an oncologic colorectal resection. For lesions in the distal third of the rectum, a per anal full-thickness excision followed by an adjuvant chemoradiation may be an alternative. The box below summarizes malignant colorectal polyps requiring oncologic bowel resections:
ISSN:0039-6109
DOI:10.1016/S0039-6109(02)00043-9