Laparoscopic-Assisted Colonoscopy With Polypectomy (LACP): Follow-up Data on Polyp Recurrence Rates at Initial Post-LACP Surveillance Colonoscopy: 1262

Introduction: For difficult-to-remove polyps in the right colon, laparoscopic hemicolectomy (LHC) is often employed. Laparoscopic-assisted colonoscopy with polypectomy (LACP) has been utilized in this scenario to manipulate the colon in such position that allows the endoscopist complete polyp resection without removal of an entire segment of colon. In a randomized controlled trial (RCT), we recently showed LACP to be equivalent to LHC in terms of overall efficacy and complications, yet with roughly half the hospital length of stay. The aim of this study was to assess the rate of early local polyp recurrence in those patients that were initially randomized to LACP. Methods: This was a retrospective analysis of follow-up data collected in our original RCT comparing LACP to LHC. Data on surveillance colonoscopy post-LACP was available in 10 of 17 patients initially randomized to LACP between 2009 and 2013. Clinical, endoscopic and pathologic data were recorded for all available procedures. Results: The mean time to initial surveillance colonoscopy after LACP was 15.3 months. Only one patient (10%) had polyp recurrence at the site of prior LACP. A total of 9/10 (90%) patients had no evidence of polyp regrowth, and 7 of these patients (78%) had biopsies of the scar site further documenting the absence of neoplasia. Seven patients total (70%) had new polyp occurrences at other sites. There were 18 new polyps detected: 1/18 (5.6%) in the cecum, 4/18 (22.2%) in the ascending colon, 1/18 (5.6%) in the transverse colon, 1/18 (5.6%) in the descending colon, 6/18 (33.3%) in the sigmoid colon, and 5/18 (27.8%) in the rectum. Histology amongst the new polyps found were hyperplastic lesions 9/18 (50%), tubular adenomas 7/18 (38.9%), tubulovillous adenoma 1/18 (5.6%), and serrated adenoma 1/18 (5.6%). One patient was found to have a newly diagnosed adenocarcinoma in the cecum; a site different from the original LACP. Conclusion: The efficacy of LACP appears durable, as 90% of patients were without polyp recurrence at a mean of 15.3 months of follow-up. Patients that have undergone LACP require aggressive colonoscopic surveillance, as the likelihood of new polyp occurrence at sites different from the original LACP is quite substantial.Figure 1