ENDOSCOPIC APPROACH VERSUS RESECTIVE SURGERY IN COMPLEX BENIGN COLONIC LESIONS

Aims To describe the characteristics of complex benign lesions treated either by colonoscopy or surgically, and to compare the rate of complications.

Methods Unicentric, observational, restrospective study. We included a cohort of benign colonic lesions surgically treated between 2004-2021, compared with another cohort of complex (SMSA≥3) benign lesions endoscopically treated between 2018-2021. Adenocarcinoma or invasive histology and transanal surgery treated lesions are excluded.

Results 240 lesions (232 patients) were included, 136(56.6%) in the endoscopic cohort. 67.1% male, average age 68±0,66 (p>0.05). There were 70(51.5%) SMSA 4 lesions in the endoscopic group versus 78(75%) in the surgical one (p<0.001). 144(60%) lesions were located in right colon (p>0.05). 213(88.8%) lesions were adenomas and 27(11.3%) serrated lesions (p>0.05 between groups). There were 32(23.5%) high grade dysplasia lesions in the endoscopic group versus 57(54.8%) in the surgical one (p<0.001). Attending to the Paris classification: 56% of the endoscopic group lesions were 0-IIa, median size 30(25-45)mm; 42.3% of the surgical group lesions were 0-Is, median size 40(30-53)mm (p<0.01). There were severe complications in 36 (34.6%) patients in the surgical group versus 1 in the endoscopic group (0.7%)(p<0.001), and 3(2.9%) deaths in the surgical group versus 1(0.7%) death in the endoscopic gorup (p<0.001). The length of hospital stay median was 10.5(7-23) days in the surgical group versus 0 days in the endoscopic one (p<0.001).

Conclusions The endoscopic treatment of complex benign colonic lesions (SMSA≥3) associates lower mortality rates, severe complications and shorter length of hospital stay. We recommend establishing specific reference agendas for this type of lesions.

Publication History

Article published online:
14 April 2022