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90th Annual Meeting Abstracts

Colectomy For Colonic Polyps in The Era of Minimally Invasive Surgery: Are We Following Oncologic Principles?
*Mandip Joshi, MD, *Jose M Pimiento, *Jimmy Hawkes, MS, Stanley J Dudrick, MD, *Michael Ajemian, MD
Saint Mary's Hospital, Waterbury, CT

Objective: To evaluate the outcomes and pathologic results of patients undergoing colectomy for endoscopically unresectable colonic polyps
Design: Retrospective chart review
Setting: Teaching community hospital
Patients: All patients who underwent colonic resection for polyps from January 2003 to December 2007
Interventions: Colonic resection for endoscopically unresectable colonic polyps
Main Outcome Measures: Residual malignancy and lymph node involvement in resected specimens
738 patients had colon resections, of which 55(7.1%) patients had colon resection for colonic polyps. The mean age at diagnosis was 64 y(32-87y). 50% of patients were male. 6(11%) were scheduled as open procedures, the rest were laparoscopic, with a conversion rate to open of 10%. The mean resected specimen length was 15cm(SD 6.2cm). The mean lymph node retrieval was 7(SE 0.641). The lymph node yield did not correlate with the type of procedure, operative approach (open vs. laparoscopic), surgeon, length of specimen, preoperative diagnosis (benign vs. malignant), or final diagnosis. The rate of complications was 11%. Malignant disease was found in 8(23%) of 34 patients with a preoperative diagnosis of non-malignant polyps. Only one patient was confirmed to have nodal involvement
Conclusions: Colectomy for colonic polyps was performed laparoscopically in most of the patients with a low complication and conversion rate. The mean lymph node retrieval was 7 which is below the national recommended lymph node accrual for colectomies for cancer, and did not correlate with surgical approach or preoperative diagnosis. This finding may represent surgical or pathological technique bias which may affect the ability to detect lymph nodes in this patient population. These results highlight the need for standard surgical and pathological procedures to assure appropriate staging in these patients


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