Abstract
Colorectal cancer screening programs result in an early diagnosis of the disease. In 2007, 250 malignant polyps were identified in Lombardy, out of 1,329 screen-detected colorectal carcinomas. The Italian Group for Colorectal Cancer (GISCoR) promoted the multicentric study “Endoscopic Follow-up versus Surgical Radicalization of Malignant Polyps after Complete Endoscopic Polypectomy” (SEC-GISCoR). The protocol was a multicentric, prospective, observational, non-randomized study. It included patients diagnosed a colorectal malignant adenoma, after complete endoscopic removal. From November 2005 to September 2009, three participating centers enrolled 120 patients with malignant polyps after “complete” endoscopic polypectomy; malignant polyps were classified as “low risk” or “high risk”. The study had two arms: “Intensive follow-up” (42 patients: 32 with low-risk and 10 with high-risk polyps) and “Surgical radicalization” (78 patients: 5 with low-risk and 73 with high-risk polyps). Data were collected using an online CRF. Overall, 37/120 polyps (30.8%) were low risk and 83/120 (69.2%) were high risk. 42 out of 120 patients (35%) were enrolled in the “clinical follow-up” arm, while 78/120 (65%) entered the surgery arm. In 15 cases, patients were not enrolled in the correct arm, according to the criteria agreed upon before starting the study. There still is a high incidence (11.5%) of pathological mismatches. No clinical event was reported in 2.9 years of follow-up. In conclusion, some differences emerged in the management of patients with malignant polyps among participating centers (p < 0.001), mismatches can be explained by high surgical risk or patient’s choice. Only in 5 cases (4.2%), did data analysis not allow to exactly determine the reason for a choice different from protocol criteria. The availability of new risk factors and the evidence of pathological mismatches confirmed the need for future studies on this issue.
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Acknowledgments
We thank Romano Sassatelli (Division of Endoscopy, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy), Giuliana Sereni (Division of Endoscopy, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy), Darina Tamayo (Division of Endoscopy, European Institute of Oncology, Milan, Italy), Antonio Chiappa (Division of General and Laparoscopic Surgery, European Institute of Oncology, Milan, Italy; University of Milan, Milan, Italy), Pasquale Misitano (University of Milan, Milan, Italy), Giorgio Gardini (Pathology Department, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy) for their great contribution to this paper. Luca Clivio (Computer engineer, Istituto Mario Negri) for creating the software used for data management. Mauro Risio (IRCC Candiolo Pathologist—Turin) as Author of the GISCoR document “Diagnosi anatomo-patologica negli screening del carcinoma colon retto: le indicazioni” (2005) and for his collaboration for histological revision of specimens. Nordiana Baruzzi (European Institute of Oncology, Milan) for English revision.
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Andreoni, B., Camellini, L., Sonzogni, A. et al. Multicentric GISCoR Study “Intensive clinical follow-up versus surgical radicalization after complete endoscopic polypectomy of a malignant adenoma” (SEC-GISCoR). Updates Surg 63, 171–177 (2011). https://doi.org/10.1007/s13304-011-0081-8
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DOI: https://doi.org/10.1007/s13304-011-0081-8