You May Not Need Surgery for Large Colorectal Polyps

Get a second opinion — you may have other options

Colorectal polyps don’t always become cancers. But the bigger ones are the most dangerous — and the most difficult to remove.

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“All colorectal cancers arise from benign, precancerous polyps, so it is important to remove them,” says colorectal surgeon James Church, MD.

“The trick is to make sure that, when surgery is recommended for a large polyp, it is really needed.”

Screening colonoscopy usually finds polyps and allows doctors to remove them (a procedure called polypectomy). But not all large polyps can be removed during colonoscopy.

“Some patients with large benign polyps are told they have to have surgery — and that part, or sometimes all, of the colon must come out,” he says.

Larger polyps pose challenges

Large polyps in a difficult area, removed without surgery.

These large polyps, in a difficult area, were removed without surgery.

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Polypectomy is less invasive, less dangerous and less disruptive for bowel function and lifestyle than surgically removing part of the colon (colectomy), a major abdominal procedure.

But large polyps can be difficult to remove during colonoscopy because:

  • They have bigger arteries, and removing them may cause substantial bleeding.
  • Removing big polyps could accidentally perforate the colon. “The wall of the right colon is thinner than the wall on the left, so removal of right-sided polyps is more risky,” says Dr. Church.
  • Some large polyps are awkwardly positioned or too flat to be easily snared. “Others are just too big,” he notes.
  • Some polyps look suspiciously like early cancers and should not be snared.

For these reasons, some doctors may refer patients with large polyps for colectomy. “However, any complications can be quite serious and may lead to a temporary colostomy,says Dr. Church.

Tiny knives sent through a scope

A newer option — for a small group of patients with large colorectal polyps — is endoscopic submucosal dissection (ESD).

“ESD is an advanced way of doing surgery through the colonoscope, using tiny knives to cut away the polyp and save the colon,” says Dr. Church.

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The risk of perforating the bowel is higher with ESD than with polypectomy, he notes. But ESD does have the potential to spare patients from colectomy.

First step: A second opinion

If you have a large, benign colorectal polyp and surgery was recommended, remember that it may not be your only option.

“Removing polyps gets trickier as they get bigger. But be sure to get a second opinion from a doctor experienced in advanced polypectomy techniques,” says Dr. Church. “Some of us may be more comfortable removing large polyps than others.”

Meanwhile, he adds, doctors will continue to push the boundaries and find better ways to remove the polyps that cause colorectal cancer.

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