Role of Endoscopic Resection Versus Surgical Resection in Management of Malignant Colon Polyps: a National Cancer Database Analysis

被引:10
作者
Lowe, Dhruv [1 ]
Saleem, Sheikh [1 ]
Arif, Muhammad Osman [1 ]
Sinha, Shreya [2 ]
Brooks, Gary [3 ]
机构
[1] SUNY Upstate Med Univ, Dept Med, Div Gastroenterol & Hepatol, Syracuse, NY 13202 USA
[2] SUNY Upstate Med Univ, Dept Med, Div Hematol & Oncol, Syracuse, NY 13202 USA
[3] SUNY Upstate Med Univ, Ctr Res & Evaluat, Dept Publ Hlth & Prevent Med, Syracuse, NY 13210 USA
关键词
Colonic neoplasms; Adenocarcinoma; Colectomy; Endoscopic mucosal resection; Cohort studies; COLORECTAL POLYPS; RISK-FACTORS; POPULATION; SURVIVAL; OUTCOMES; TRENDS;
D O I
10.1007/s11605-019-04356-0
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background Endoscopic resection (polypectomy) or surgery, are the main approaches in management of malignant colon polyps. There are very few large population-based studies comparing outcomes between the two. Methods Using the National Cancer Database, we identified patients >= 18 years with the first diagnosis of T1N0M0 malignant polyp from 2004 to 2015. Patients with a positive resection margin were excluded. Outcomes were compared between those who had surgery versus those who had polypectomy. Overall survival was compared using Kaplan-Meier curves. Multivariate Cox proportional hazards analysis was performed to generate hazard ratios, adjusted for patient, demographic, and tumor factors. Results A total of 31,062 patients met the inclusion criteria, out of which 2593 (8.3%) underwent polypectomy alone and 28,469 (91.7%) had surgery. Overall survival was significantly better in the surgical group compared with the polypectomy group. One-year and 5-year survival for surgery were 95.8% and 86.1% respectively compared with 94.2% and 80.6% for polypectomy (p < .0001). Hazard ratio for surgery after adjusting for various clinical-, demographic-, and tumor-level factors was 0.53 (p < .0001). Conclusion Our study is the largest population-based analysis of patients with T1N0M0 malignant colon polyps. Overall survival was higher in patients who underwent surgery compared with polypectomy. This remained consistent even after adjusting for multiple patient and tumor factors between the two groups.
引用
收藏
页码:177 / 187
页数:11
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