Full-thickness excision is a lot easier to execute from the anus, playing with either a vintage transanal processes otherwise TEMS

Toward reason for that it declaration, cancerous polyps of the anus and you can anus was considered together with her as they both occur from large-bowel mucosa, from the same pathways. Whilst the this will be simpler, you will find differences in both websites which might be reflected during the the different techniques utilized for excision out-of an excellent polyp on rectum and about anus. Thus, resection out of ‘early’ rectal tumours vary from T2 and even T3 tumours, also T1 sores. In addition, the therapy formulas getting rectal disease are very more complicated having the expanding development to utilize adjuvant radiation therapy either preresection otherwise postresection in which histology was quicker beneficial.

The conventional remedy for a carcinoma of your anus or anus try major resection of one’s part from intestinal who has the new tumour, utilizing the regional lymphatics; a system in the tall morbidity and you may death. In such cases, polypectomy alone is actually deemed useless medication. Assessing the risk of residual condition after the polypectomy is dependant on details one to anticipate the possibility of locoregional reoccurrence. These are generally the shape and you may morphology of tumour, the technique of resection, this new resection margin, the amount of differentiation, the breadth of attack and you will lymphovascular intrusion 132 . Adverse result in a cancerous colorectal polyp is understood to be recurring cancers during the good resection specimen and local or metastatic reappearance inside the new go after-upwards several months 134 .

Polyp morphology

These days it is more successful that risk of lymphovascular metastases are higher which have sessile polyps than simply with pedunculated polyps, and therefore the fresh new prognosis into previous is poorer 149 . Cooper et al. 17 claimed a population-oriented studies out-of colonoscopic polypectomy in contrast to businesses inside 2077 people treated ranging from 2002 and you will 2005. They reported that more than one-3rd out of clients having cancerous polyps were treated with colonoscopic polypectomy. But not, it advised you to definitely polyps which were sessile, in place of pedunculated, were faster amenable so you can colonoscopic government and may have been subjected in order to medical resection due to the fact a primary choices. The outcomes was equivalent both in organizations. It should be recalled the analysis is observational there is high range to have options prejudice from the allowance off procedures. Additionally, nothing analysis was indeed included into the accepted prognostic signs apart from the latest degree of differentiation of your own cancer.

Margin out-of resection

Malignant tumors during the otherwise around the resection ination boosts the risk to have an adverse outcome 14, 131, 150 . Boenicke ainsi que al. 151 reported that the fresh new concurrence out of histologically positive resection margins and you may sessile morphology try an essential chance basis for lymph node metastases immediately after complete endoscopic removal of cancerous colorectal polyps. They seen 105 patients which have cancerous polyps exactly who underwent polypectomy, simply over 50 % of which were regarding the rectum. Just 39 people had histologically displayed tumour-free resection margins. Further surgery was performed otherwise realize-up examinations done in these customers. Local recurrence otherwise recurring carcinoma is noted within modern website of one’s malignant polyp inside three people and you will metastases to the regional lymph nodes have been found in seven (eight.6%). It determined that histologically partial removal and you may lymphatic infiltration showed an excellent significant correlation to the exposure away from lymph node metastases not which have remnant tumour.

It is generally accepted that the risk of lymph node metastases, residual tumour or recurrence is < 2% in resected malignant polyps where the margin of resection is > 1 mm and there are no other adverse histological features 130, 135, 152 . Cooper et al. 69 reported that when a pathologist detects invasive elements at a resection margin, or when the clearance to the margin is < 1 mm, the rate of recurrence increases to up to 33%. It is widely considered that a negative resection margin of ? 2 mm for invasive cancer cells results in a very low probability of residual cancer 69, 153-156 . Masaki et al. 157 concentrated on the appearance of tumour at the invasive margin. The presence of small nests of tumour cells with poor differentiation or a mucinous appearance at the invasive margin of the tumour (not the resection margin) was associated with an adverse outcome (either lymph node involvement or residual tumour in the wall) in five of 24 (21%) malignant polyps with an unfavourable margin compared with one out of 41 (2.5%) malignant polyps without these unfavourable histological features at the invasive margin.