Outcomes of surgical resections for benign colon polyps: a systematic review

Michael P.M. de Neree tot Babberich; Maxime E.S. Bronzwaer; Jurr O. Andriessen; Barbara A. J. Bastiaansen; Nahid Mostafavi; Willem A. Bemelman; Paul Fockens; Pieter J. Tanis; Evelien Dekker

doi:10.1055/a-0962-9780

Endoscopy, Table of Contents

Endoscopy 2019; 51(10): 961-972
DOI: 10.1055/a-0962-9780

Review

Outcomes of surgical resections for benign colon polyps: a systematic review

Michael P.M. de Neree tot Babberich‡^*

¹Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands

²Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands

,

Maxime E.S. Bronzwaer‡^*

¹Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands

,

Jurr O. Andriessen

¹Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands

,

Barbara A. J. Bastiaansen

¹Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands

,

Nahid Mostafavi

³Biostatistical unit, Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands

,

Willem A. Bemelman

²Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands

,

Paul Fockens

¹Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands

,

Pieter J. Tanis

²Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands

,

Evelien Dekker

¹Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands

› Author Affiliations

Abstract

Background Not all benign colonic polyps are suitable for endoscopic resection, although criteria for endoscopic non-resectability vary worldwide. Clinical decision-making largely depends on endoscopic treatment options, as well as postoperative risks after surgical resection. This systematic review aimed to determine postoperative outcomes and the characteristics of surgically resected benign colonic polyps.

Methods MEDLINE, EMBASE, and the Cochrane Library were searched for studies investigating the outcomes of surgical resection for benign colonic polyps since 1980. Studies were considered eligible when at least one postoperative outcome (morbidity and/or mortality) was reported. Meta-analyses were conducted for the primary outcome measures (morbidity and mortality) for studies that included patients only after the year 2000.

Results Of the 4210 studies retrieved, 26 studies describing 139 897 patients were included. The most common indications for surgical resection were polyp location in the right-sided colon, non-pedunculated morphology, and large polyp size. The pooled 1-month complication and mortality rates of studies that included patients after the year 2000 were 24 % (95 % confidence interval [CI] 15 % – 36 %) and 0.7 % (95 %CI 0.6 % – 0.8 %), respectively.

Conclusion The postoperative morbidity and mortality after colonic resection for benign polyps are substantial. Referral to an advanced interventional endoscopist should be considered before referral for surgery to evaluate the possibilities for endoscopic treatment of large, non-pedunculated, and/or colonic polyps in difficult locations without suspicion of submucosal malignant invasion.

Full Text

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