Laparoscopic wedge excision as an alternative for laparoscopic oncological colon resection in benign endoscopically unresectable colon polyps.

AIM: The aim of this study was to investigate whether laparoscopic (hybrid) wedge resection (LWR) could be a less invasive and safe alternative for laparoscopic oncological colon resection (OCR) for patients with an endoscopically unresectable, suspected benign, colon polyp by comparing clinical and histological outcomes.

METHOD: All patients with endoscopically unresectable colon polyps, who were referred for surgery between 2009 and 2018, without biopsy-proven colon cancer, were identified from a prospectively maintained database. Patients with macroscopic features of malignancy during endoscopy were excluded. Clinical and histological results of patients who underwent OCR or LWR were reviewed.

RESULTS: One-hundred-and-twenty-two patients were included. Ninety-seven patients underwent OCR and 25 LWR. Major complications occurred in 16.7% (n=16) of the OCR group compared to 4.0% (n=1) of the LWR group (p=.06). The anastomotic leakage rate was 6.3% (n=6) and the mortality rate 3.1% (n=3) in the OCR group. No anastomotic leakage or death occurred in the LWR group. The median length of hospital stay after OCR was 5 days (IQR 5-9) compared to 2 days (IQR 2-4) after LWR (p<0.0001). Definite pathology showed a malignancy rate of 4.2% (n=4) in the OCR and 4.0% (n=1) (without high-risk features) in the LWR group.

CONCLUSION: This study shows that LWR was associated with significantly lower complication rates and acceptable oncological risks in comparison to OCR. Therefore, we suggest that LWR is a safe alternative treatment, next to other endoscopic options. Which treatment is most suitable for the patient, should be discussed in a multi-disciplinary meeting.