Polypectomy: a way to prevent colorectal cancer
Written by:Dr. Enzo Masci, an expert in Gastroenterology in Milan, explains what is endoscopic polypectomy and how this can help prevent colorectal cancer
What are intestinal polyps?
Intestinal polyps are excrescences of the intestinal mucosa that are formed in the colon and rectum: usually of benign nature, some of them can grow larger and then degenerate and become malignant. Discovering and removing colon polyps (adenomas) is therefore very important as polyps are the precursors of colon cancer. To remove the polyps therefore means to interrupt the process that leads to colon cancer (adenocarcinoma).
It is in fact shown by the experience accumulated with the colon cancer screening, that to perform a colonoscopy after 50 years, remove any polyps found and adhere to subsequent controls is able to reduce the onset of colon cancer and even mortality linked to it.
What is polypectomy?
Polypectomy is a procedure that is performed endoscopically. It consists in the removal of the polyps, which can be presented with a base of implant with or without a pedunculated or sessile polyp pedicle. Some fragments or the entire polyp are subsequently recovered for histological examination. The removal of the polyp is done by means of a particular electric scalpel in the shape of a loop which, in a completely painless way, cuts the polyp cauterizing (healing) the base.
In the case of sessile polyps, ie without stalk, a different technique called mucosectomy is used. This procedure involves the removal of the mucosa of an area with poorly detected lesions or a large implantation base. The lesions may be benign or malign in the initial phase, not infiltrating the deep layers of the wall: in this way the removal resolves the pathology in a definitive way.
To remove the mucosa and the polyp, the latter is lifted and liquid is infiltrated below it, thus artificially creating a peduncle. The risks are less than those of a surgical operation with total anesthesia even if performed with laparoscopic technique (the technique with which you work by introducing the surgical instruments through some small holes made in the abdomen, instead of the classic surgical cut).
This treatment, which is performed on an outpatient basis or in Day Hospital, has a duration ranging from 15 to 90 minutes and takes place by introducing a small flexible tube equipped with a camera or optical fibers in the rectum (colonoscopy) or in the mouth (gastroscopy) up to get to the point where the polyps were found.
What are the risks?
The risks of polypectomy are less than those of surgery, even when large intestinal polyps are removed. For this reason, today surgery is used only to remove malignant tumors that have already infiltrated the deep layers of the intestinal wall.
However, it is necessary to turn to Centers and experienced professionals because the removal of large polyps is of the flattest ones requires more complex techniques.
For this reason, even in Lombardy, a region known for the high quality of health, almost 20% of polyps that can be removed by endoscopy, are still operated by surgery.
Like any invasive procedure, polypectomy is also subject to complications, including:
• Small hemorrhages at the polyp removal site (3% of cases);
• Perforation of the intestinal wall (0.3-0.4% of cases)
These two complications generally diagnosed during the procedure can be resolved by endoscopy. Only in very rare cases will it be necessary to perform a surgical procedure.
Why is polypectomy important for cancer prevention?
After the lung and the breast, the colorectal cancer is among the most widespread. In addition to leading a healthy lifestyle, it is essential to make checks every 5-10 years from the age of 50, the age in which the polyps that are the precursors of colon cancer usually begin to appear and their removal through polypectomy prevents tumor formation.
It should be emphasized that the colonoscopy, performed in all the best centers with a sedation that cancels almost every nuisance, is no longer an annoying and painful examination.
Even the intestinal preparation, fear of many patients, today is much simpler and less annoying because a laxative is on the market for a few days, which ensures excellent preparation by drinking only half a liter of solution the afternoon before the exam and half a liter before exam.