Purpose: After endoscopic polypectomy, the risk factors for malignancy include positive margin, poor tumor differentiation, deep submucosal and lymphovascular invasion. Even in the presence of high-risk factors, residual disease is observed in less than 15% of samples, and even less in lymph nodes. Study aimed to evaluate results of patients after radicalization in a non-curative polypectomy in 10 year follow-up period, and to compare classical and transanal approach and their impact on quality of life and disease-free survival. Results: Cohort include 45 patients, three patients had adenocarcinoma in situ, one of them positive lymphatic nodes. Only seven (23 %) patients had 12 and more lymph nodes described. TEM cohort had significantly shorter hospital stay (median 7 vs. 11 days, p < 0.0001), significantly lower incidence of herniation (0% vs. 30%, p = 0.020), shorter distance of tumor from the anal verge (median 7 vs. 23.5, p < 0.0001), and lower number of lymph nodes (median 0 vs. 5, p < 0.0001). Overall survival was without statistical significance (p = 0.690). The group of classically operated had higher proportion of subsequent procedures and limitations (p=0.149, and p=0.540). Conclusion: Following malignant polypectomy, surgery should be considered in medically fit patients if the polypectomy margin is positive, unknown, or if the lymphovascular invasion is present. TEM surgery is an acceptable option for high-risk patients . Identifying patients requiring surgery for possible lymph node metastases is still the most important problem.

Department of Surgery 1 University Hospital Olomouc Faculty of Medicine and Dentistry Palacky University Olomouc

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