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Management of malignant colonic polyps: A population-based analysis of colonoscopic polypectomy versus surgery†
Article first published online: 12 JUL 2011
Copyright © 2011 American Cancer Society
Volume 118, Issue 3, pages 651–659, 1 February 2012
How to Cite
Cooper, G. S., Xu, F., Barnholtz Sloan, J. S., Koroukian, S. M. and Schluchter, M. D. (2012), Management of malignant colonic polyps: A population-based analysis of colonoscopic polypectomy versus surgery. Cancer, 118: 651–659. doi: 10.1002/cncr.26340
We acknowledge the efforts of the Applied Research Program, National Cancer Institute; the Office of Research, Development and Information, Centers for Medicare & Medicaid Services; Information Management Services, Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database.
- Issue published online: 20 JAN 2012
- Article first published online: 12 JUL 2011
- Manuscript Accepted: 16 MAY 2011
- Manuscript Revised: 15 APR 2011
- Manuscript Received: 9 MAR 2011
- colonic polyps;
- SEER program
The management of colon polyps containing invasive carcinoma includes surgical resection or colonoscopic polypectomy. To date, there are very limited population-based data comparing outcomes with the 2 management approaches.
Using the linked Surveillance Epidemiology and End Results–Medicare database, we identified 2077 patients aged ≥66 years with an initial diagnosis of stage T1N0M0 malignant polyp from 1992-2005. Patients were categorized as surgical or polypectomy depending on the most invasive treatment. To adjust for potential selection bias in treatment assignment, using multivariate analysis, patients were divided into quintiles of likelihood of polypectomy (propensity scores), and outcomes were compared in each quintile.
Surgical resection was performed in 1340 (64.5%) patients and polypectomy was performed in 737 (35.5%) patients. Predictors for undergoing polypectomy (P<.001) included older age, greater comorbidity, no history of polyps, diagnosis in 2002 or later, left colon site of cancer, well-differentiated tumors, and colonoscopy performed in an outpatient setting. Both 1-year and 5-year survival were higher in the surgical group (92% and 75%, respectively) than in the polypectomy group (88% and 62%, respectively). The unadjusted hazard ratio was 1.51 (95% confidence interval [CI], 1.31-1.74). After adjusting for propensity quintile, the hazard ratio was 1.15 (95% CI, 0.98-1.33). Within each propensity quintile, the risk of death was similar between the 2 groups (interaction test P = .96).
In this large, population-based sample, more than one-third of patients with malignant polyps were treated with colonoscopic polypectomy. Outcomes were similar to surgical patients with comparable clinical characteristics and could be offered to patients who meet appropriate clinical criteria. Cancer 2012;. © 2011 American Cancer Society.