M. Qi1, M. Kiely1, L. Chen1, J. Yoo1 1Tufts Medical Center,Colon And Rectal Surgery,Boston, MA, USA
Introduction: Despite advanced endoscopic techniques, some benign-appearing colon polyps are not removable endoscopically. Surgical resection is typically recommended, even though the majority of these polyps do not contain cancer. Combined Endo-Laparoscopic Surgery (CELS) is emerging as an alternative to bowel resection in this setting. Simultaneous laparoscopy with CO2 colonoscopy may increase the chance of successful polyp removal without the need for a bowel resection. However, short-term outcomes regarding this technique have not been widely reported. Our goal was to review the CELS experience at our institution and evaluate short-term outcomes.
Methods: This is a single institution, retrospective analysis of all patients who underwent CELS from December 2014 to August 2016. Patient demographics, operating room characteristics, pathology, and post-operative outcomes were analyzed on an intention to treat basis.
Results:We identified 11 patients with endoscopically unresectable polyps who underwent an attempted CELS procedure from December 2014 to July 2016. Of these 11 patients, 10 (91%) had successful polyp removal using the CELS technique. One patient had a fixed polyp that required a laparoscopic right colectomy. Her pathology was consistent with a tubular adenoma.
For all patients, the mean operating room time was 180 ± 58 min, and the median length of stay was 1 day (range 0-3 days). Post-operative complications occurred in 1 patient, who developed a post-polypectomy bleed following resumption of anti-platelet therapy. Of the 10 patients who had a successful CELS procedure, 9 of these polyps were ultimately benign (90%) and adenocarcinoma was present in one. This patient underwent a laparoscopic right colectomy 12 days later. The final pathology was consistent with a T1N0 cancer (0/20 lymph nodes).
Conclusion:The endoscopic and surgical management of benign colon polyps continues to evolve. CELS may be an alternative to bowel resection in select patients, and may be associated with improved patient outcomes and lower morbidity. The inability to accurately determine the presence of cancer in these polyps is a limitation to this approach, and requires a thoughtful pre-operative discussion regarding the need for additional surgery following CELS.