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US Task Force Issues Guidelines on Malignant Polyp Management
The US Multisociety Task Force on Colorectal Cancer has published new guidelines that include 6 recommendations for identification and management of malignant colorectal polyps, and a clinical decision support tool.
The task force, which includes members of the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy, observed that “the optimal approach to management of malignant polyps begins with a thorough and knowledgeable endoscopic assessment designed to identify features of deep submucosal invasion.”
The recommendations call for endoscopic biopsy of nonpedunculated lesions that show indications of deep submucosal invasion, followed by surgical resection. When submucosal invasion is not suspected but a high risk of superficial invasion of the submucosa exists, then en bloc resection should be considered.
The task force also strongly supports a multidisciplinary approach to each patient, in which the primary care provider and any other medical specialists caring for comorbid conditions, such as cardiovascular disease, work with the endoscopist to recommend treatment options to the patient. “The main question to address is whether the individual should undergo adjuvant surgical resection, and the answer requires weighing the risk of residual cancer or risk of recurrence after endoscopic resection vs the risk of surgical resection,” the guidelines state.
Other factors that must be considered include age, comorbidities, and patient preferences, in addition to the type, size, and histology of the polyps.
“When pathology reports cancer in a lesion that was completely resected endoscopically, the decision to recommend adjuvant surgery is based on polyp shape, whether there was en bloc resection and adequate histologic assessment, the presence or absence of unfavorable histologic features, the patient's risk for surgical mortality and morbidity, and patient preferences,” the task force stated in its guideline.
—Rebecca Mashaw
Reference:
Shaukat A, Kaltenbach T, Dominitz JA, et al. Endoscopic recognition and management strategies for malignant colorectal polyps: Recommendations of the US Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol. 2020; 115(11): 1751-1767.
