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Surgical management of colorectal polyps

This discussion deals with the management of pedunculated and sessile adenomatous and retention colorectal polyps but excludes villous adenomas. All polyps within the range of the sigmoidoscope should be completely removed and submitted for microscopic study. Adenomatous polyps that reveal atypia, carcinoma in situ, and cancer just beneath the muscularis mucosae, not invading the base of the stalk, are cured by local excision and require no further treatment. Polypoid lesions that reveal invasive cancer or involvement of the base of the stalk require an appropriate cancer operation. Asymptomatic polyps above the level of the sigmoidoscope seen on barium enema with air contrast examination that are less than 1.2 cm in diameter may safely be observed by barium enema examinations at regular intervals, i.e. every 6 months. However, we recommend excision for all polyps, regardless of size, in all patients whose general condition will permit. If the polyps are greater than 1.2 cm in size, because of the increased danger of cancer, surgical excision is strongly advised. The treatment for juvenile polyps, familial polyposis, Gardner's syndrome, and Peutz‐Jeghers' syndrome will be discussed.