| Polypectomy alone is adequate treatment for colorectal polyps with early invasive cancer if specific histologic criteria are met: |
- The polyp is considered to be completely excised by the endoscopist and is submitted in toto for pathological examination.
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- The polyp is fixed and sectioned so that it is possible to accurately determine the depth of invasion, grade of differentiation, and completeness of excision of the carcinoma.
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- The cancer is not poorly differentiated.
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- There is no vascular or lymphatic involvement.
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- The margin of the excision is not involved. Invasion of the stalk of pedunculated polyp, by itself, is not an unfavorable prognostic finding, as long as the cancer does not extend to the margin of stalk resection.
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- No extension beyond the submucosa.
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- Local staging (MRI, ultrasound) reveals no suspicion for deeper invasion or positive lymph nodes.
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- In addition, appropriate patients for endoscopic management of large (≥2 cm) pedunculated polyps include those in whom the concern for invasive cancer is low, and the size and location of the polyp are amenable to endoscopic resection with a relatively low risk of complications.
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