Why does location of the polyp effect treatment strategy?
Mr. Miles discussed the implications of polyp location in regards to the different treatment options during the 5th International Controversies in Rectal Cancer Conference 2017, held in London (UK) in October 2017.
In order to plan the surgery, it is essential to determine whether a polyp is at the sphincter level, intra or extraperitoneal, as it will determine whether a partial or a full thickness excision is performed. Previously, a clinical exam, rectoscopy and MRI provide significant information on polyp location. Size, macroscopic appearance, and both the lower and upper edges of the polyps are very important to report as they will guide decision-making. If there are any malignancy concerns, full staging of the patient should be ordered. If an unfavorable pathology is found, completion surgery should be performed within 6 weeks in order to achieve similar results to initial total mesorectal excision cases.