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Canadian Journal of Gastroenterology
Volume 4, Issue 9, Pages 549-553
Colon and Rectum

The Malignant Polyp - When to Operate: The St. Mark’s Experience

Christopher B Williams and John M Geraghty

St Mark’s Hospital, London, UK

Copyright © 1990 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The world literature on malignant polyps suggests that those removed endoscopically with recognized favorable histological features for conservative management have excellent prognoses without surgery. Many sessile or 'uncertainly removed' malignant polyps after endoscopic polypectomy also show no evidence of residual cancer, suggesting that referral for surgical resection is not invariably in the best interests of elderly or poor surgical risk patients. St Mark's experience of five year follow-up of 62 patients with malignant polyps judged 'completely excised' showed three cancer-related deaths (of uncertain primary) in 78- to 81-year-old patients. Of 18 patients with malignant polyps 'incompletely excised,' seven had no cancer found at surgery, 10 were well without surgery and one died from carcinomatosis following delayed surgery. These generally encouraging results are further evidence that 'knee jerk surgery' for malignant polyps is inappropriate.