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Good News About Difficult Colon Polyps

Good News About Difficult Colon Polyps

Every year tens of thousands of people face serious colon surgery to remove big polyps before they can morph into colon cancer. Many have part of their colon removed at the same time—and face a long, painful recovery. Now an important study shows that for most, it may be safe to simply snip out even large polyps during a colonoscopy.

Although most polyps are removed during colonoscopy, if they’re big—about three-eighths of an inch across, the size of a marble or bigger—or in a hard-to-reach spot, colon surgery is often recommended, even though doctors aren’t sure if the polyp is cancerous.

For the study, researchers at the Cleveland Clinic (where Dr. Mike is Chief Wellness Officer) checked the health records of 439 people who’d undergone colon surgery for a polyp. Turns out a whopping 92 percent of big polyps were benign. Just 8 percent had signs of cancer or precancerous cells. “Our study is a real eye opener; it’s the first step showing the low incidence of cancer in these large polyps,” says the lead researcher, Emre Gorgun, M.D., FACS, FASCRS, a staff surgeon in the department of colorectal surgery. “Ninety-two percent of patients had their colon removed for noncancerous reasons.”

Here’s why we think this study is significant—and why you or a loved one may someday think the same: The researchers conclude that sparing the colon by removing only the big polyp would be just as effective, in terms of cancer prevention, for many people as removing the colon. And it would let thousands sidestep the risks and side effects of colon-removal surgery, also known as colon resection or colectomy.

Colon resection doesn’t come for free—it’s a major abdominal operation associated with the risk of serious adverse events,” Dr. Gorgun notes. This procedure is done under general anesthesia and often involves a six- to eight-inch incision in the abdomen. Several inches of the colon are removed. The remaining sections are then stitched or stapled back together. Risks include leakage from the colon into the abdomen and infections. Recovery can be painful, could keep you out of work for up to three weeks and involves restricting activity and following a special diet for a month or more. In this study, nearly one in five people who had colon resections for polyps had complications within a month of their surgery.

According to the American Cancer Society, more than 134,000 people will be diagnosed with this cancer and more than 49,000 will die from it this year. The good news: Cancer rates are dropping as more people get colonoscopies, the gold standard screening test where doctors check for and remove suspicious polyps that could become cancerous. The United States Preventive Services Task Force recommends screening start at 50 and continue as needed up to age 75 (older or younger screenings can be decided by your doctor). Yet one in three adults hasn’t been screened. Perhaps that’s why colorectal cancer is still the second-leading cause of cancer deaths in America.

If your colonoscopy turns up a big or hard-to-reach polyp, ask your doctor if you really need a colon resection or colectomy. There are newer techniques that show promise. They remove big polyps but leave the colon intact. They include:

  • Endoscopic mucosal resection (EMR): Fluid is injected under the polyp to protect healthy tissue. The polyp is then removed with a device called a snare.
  • Endoscopic Submucosal Dissection (ESD): Similar to EMR, but doctors use a special knife to carefully cut away the polyp. This helps protect the colon from damage and can be used to remove larger and deeper polyps than the EMR procedure can.
  • Laparoscopic-assisted endoscopic polypectomy (LAEP): Great for tough-to-reach polyps, LAEP uses tools inserted through tiny incisions in the abdomen to move the colon into a better position so that a polyp can be removed from inside your colon.
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