Polyps and Polyposis Coli

This issue of Clinics in Colon and Rectal Surgery contains the latest information on diagnosis, management, and surveillance of sporadic polyps, those that are expressed as part of a syndrome, extracolonic manifestations, and the role of prevention.

Drs. Buie and MacLean lead off with a discussion and description of the current surveillance recommendations for patients who have undergone polypectomy. Up to 30% of patients aged 50 will have an adenoma; this increases to almost half of those who live 70 years. Removal of these adenomas at colonoscopy will decrease the incidence of colorectal cancer, and surveillance to detect and remove missed synchronous polyps or cancers and new metachronous polyps or cancers has proven benefit.

A detailed description of risk factors for development of colorectal polyps follows, written by Drs. Sarah Grahn and Mika Varma. Although family history has long been recognized as increasing risk for colorectal neoplasia. They detail the influence of race, gender, smoking, obesity, and metabolic syndrome. Dr. Neal Ellis completes the discussion with a thorough review of the many familial syndromes that increase a patient's risk for colorectal polyps and cancer.

Drs. Anaya, Chang, and Rodriguez-Bigas' contribution is an extremely detailed description of common extracolonic manifestations associated with hereditary colorectal polyposis and cancer syndromes. In this article, they review the most common and clinically relevant extracolonic manifestations including incidence, presentation, genotype/phenotype correlations, and management strategies.

Serrated adenomas are becoming recognized as lesions that can degenerate into malignancy; Drs. Bauer and Papaconstantinou explore which serrated polyps are risky, how to recognize the architecture, the genetic sequence responsible, and surveillance and management strategies for these unusual adenomas.

Polyps are not limited to the adult population. Drs. Adolph and Bernabe describe how certain polyposis syndromes present in childhood, increasing risk of malignant transformation and extracolonic adenomas and malignancy. The diagnosis and management of sporadic juvenile polyps, Peutz–Jeghers syndrome and familial adenomatous polyposis, as well as rarer conditions associated with intestinal polyps, are reviewed in this article.

Management of the malignant polyp is challenging, and the evidence for various management strategies is detailed by Dr. Papaconstantinou and others. Typical endoscopic resection is often adequate, but minimally invasive techniques for surgical resection of the accompanying lymph node basin may be able to improve how we handle the highest-risk lesions. Minimally invasive techniques are also appropriate for certain rectal lesions; Drs. Touzios and Ludwig cover current methods for transanal management of rectal neoplasia, including TEM, and the risks and benefits of each algorithm.

Small bowel polyps, especially those that develop in the ileal pouch, can become malignant over time. Surveillance, management, and the role of chemoprevention are outlined by Dr. Dave O'Brien. Various chemopreventive agents, and the evidence to support or refute their use in the management of colorectal cancer risk, are detailed in an excellent article by Drs. Fajardo and Robb.

This issue concludes with an article by Dr. Birnbaum on the work-up of the constipated patient that had been scheduled for the previous issue of Clinics.

It has been a true pleasure, as well as an education for me personally, to serve as Guest Editor for Clinics in Colon and Rectal Surgery, and I thank Dr. David Beck for the opportunity to do it. This collection of outstanding articles, written by some of the best and brightest surgeons in our specialty, should serve as a reference for all who treat patients with these complex diseases that have both immediate and long-term sequelae.