0099 Colon
LESSONS FROM LAPAROSCOPICALLY-ASSISTED LARGE BOWEL
RESECTIONS FOR COLONIC POLYPS
Shpitz B, Neufield D, Tiomkin V, Ben Dahan G, Paran H, Benyamin B,
Gutman M, Klein E.
Departments of Surgery, Sapir Medical Center, Meir General Hospital, Kfar Sava,
and the Tel Aviv University Sackler School of Medicine,
Tel Aviv, Israel
Background. One of the indications for laparoscopic segmental resection of the
large bowel, are sessile colonic polyps not amenable for colonoscopic resection.
Two major reasons for this approach are the resection of premalignant
adenomas and the possibility that these lesions contain invasive carcinomas.
There is a tendency to perform a limited segmental resection in patients with a
presumably benign colonic polypoid lesions. The aim of our study was to
evaluate the effect of an “oncologically-based” approach to such polyps in a
cohort of patients who had undergone a laparoscopically-assisted colectomy for
sessile polypoid lesions.
Methods. A retrospective investigation of 25 patients who had undergone a
laparoscopic colonic resection to deal with a large sessile adenomatous polyp
which was not amenable to colonoscopic resection. All patients had undergone
laparoscopically-assisted resections of the involved bowel segment with an
extracorporeal functional stapled anastomosis for right colectomies and a
double-stapled end-to end anastomosis for left colectomies.
Results. All 25 patients were referred for resection with a preoperative
diagnosis of adenomatoid polyps with or without foci of cancer. The average
age of the patients was 71.8 years (range 51-93). In 13 (52%) patients these
polyps were located in the proximal large bowel. There were 12 right
colectomies, one - transverse colectomy and eight left colectomies or anterior
resections. The extent of colon resections were 13.8 cm for right, 15.4 cm for
left and 13 cm for transverse colectomies. Final diagnosis showed adenomas in
12 cases, invasive carcinoma in the adenomas in 9 cases and three invasive
carcinomas with residual adenoma in three cases. One patient had two
synchronous invasive cancers located in the distal transverse colon. The
average number of lymphnodes that were retrieved was 17 for invasive cancers,
and 7.6 for carcinoma in polyp. Postoperatively, the diagnosis switched from
benign polyps to invasive cancers in three patients (12 %).
Conclusion. Almost half of the patients (48%) in our study harbored either a
carcinoma in benign adenomatous polyps (36%) or invasive cancer (12 %)
indicating that a considerable percentage of these patients will harbor a
malignant disease. These data indicate that an appropriate oncologic resection is
justified for patients scheduled for laparoscopic resections due to large sessile
adenomatous polyps.