Polypectomy versus surgery in early colon cancer: size and location of colon cancer affect long-term survival

Background and Aims The colon cancer survival rate is significantly affected by location, stage, and size of the cancer. Polypectomy was shown be as equally effective as surgery in early-stage colon cancer, but there have been no established clinical guidelines in the management of colon cancer based on the size of the polyp or the tumor location. The aim of our study was to assess the early-stage colon cancer-specific survival rate in patients who underwent endoscopic polypectomy versus surgery, based on size and location of tumor in early-stage colon cancer. Methods This is a population-based nationwide study in the USA. Results Of 13,157 patients, 15.5% underwent endoscopic treatment and 84.5% underwent surgical therapy. For early cancer tumors located in the left colon, polypectomy yielded comparable 5-year survivals to surgery irrespective of size of the tumors. Five-year early cancer-specific survivals were similar for tumors located in the right colon that were < 20 mm in size (94.5 vs 94.3%, p value = 0.94). However, tumors > 20 mm in size that were located in the right colon had better survivals when treated surgically compared to those treated with polypectomy (20-39 mm: 91.8 vs 74.2%; >= 40 mm: 92.4 vs 60%, both p values < 0.01). Similar results were obtained on propensity score analysis. Conclusions Polypectomy was as effective as surgical therapy for small tumors. For larger tumors, surgical therapy is better than polypectomy for right-sided tumors, but both are equally effective for left-sided tumors.