ASCRS Ch23 — Management of Malignant Polyps

Citation: Yang D, Whiteford MH. "Management of Malignant Polyps." In: Steele SR, et al. (eds.), The ASCRS Textbook of Colon and Rectal Surgery, 4th ed. Springer Nature Switzerland AG; 2022. pp. 413–427 (PDF pp. 419–433 of the combined textbook file, incidentally captured in full during ASCRS Ch22's second Read call, PDF pp. 414–433). Source file: raw/ASCRS Textbook 4th Ed.pdf (full 1,198-page textbook; cite by page range within the single PDF). Fourth chapter of Part III ("Malignant Disease").

Type: Specialty textbook chapter (reference/background, not primary literature).

Scope

Twenty-third chapter of the sequential full-textbook ingest (see ASCRS Ch01 - Anatomy and Embryology for the ingest's scope/plan). Covers CRC precursor lesions (adenomas via the Vienna dysplasia classification, serrated polyps), carcinogenic pathways (adenoma-carcinoma and serrated pathways), the definition of a malignant polyp (pT1, submucosal invasion), lesion assessment (Paris morphology classification, Kudo pit pattern / NICE classification, the non-lifting sign), depth of invasion (Haggitt classification for pedunculated polyps, Kikuchi/Sm classification for sessile polyps, and quantitative lymph-node-metastasis risk by measured SMI depth), histopathological risk factors for lymph node metastasis (tumor grade, lymphovascular invasion, tumor budding — with systematic-review odds ratios), endoscopic resection technique for malignant polyps specifically (EMR, ESD, curative-resection criteria), transanal endoscopic surgery (TES) outcomes for malignant polyps, the ACPGBI risk-stratification tool for predicting residual disease, and recurrence/ surveillance after endoscopic resection.

Key content

This chapter substantially overlaps two already-ingested pages — Colorectal Polyps (which already had a Malignant polyps section with Haggitt/Kikuchi classification, sourced from an earlier Sabiston chapter) and Endoscopic Polypectomy, EMR & ESD (which already had full Paris/Kudo/NICE classification and EMR/ESD technique detail from ASCRS Ch05, and had explicitly flagged its own open item about cross-checking against Colorectal Polyps's malignant-polyp content). Per the wiki's established practice, this chapter's content was reconciled into Colorectal Polyps's existing Malignant polyps section — substantially expanded with quantitative SMI-depth-to-lymph-node-risk data (Kitajima et al.), histopathological risk factor odds ratios (a 23-study, 4510-patient systematic review), a formal four-criterion curative-resection definition, the ACPGBI risk-stratification tool (reproduced as a table), TES-specific malignant-polyp outcome data, and updated ESGE/JGES surveillance guidance — rather than duplicating the Paris/Kudo/NICE and EMR/ESD technique detail already on Endoscopic Polypectomy, EMR & ESD, to which the expanded section cross-links instead. This resolves that page's previously-flagged open item. Also cross-links Local Excision of Rectal Neoplasms (TES outcome data added there) and Colorectal Cancer Molecular Pathways (adenoma-carcinoma/serrated pathway background).

Limitations

• Textbook chapter, not primary literature; cited data (Kitajima SMI standardization study, the 23-study systematic review, the ACPGBI position statement's original validation, the North American rectal ESD series) are the chapter authors' synthesis, not independently re-verified.
• One specific figure — a TES sentence describing "low rates of specimen fragmentation (<10%), positive margins (66–93%), and polyp recurrence (5–11%)" — reads as internally inconsistent (a "positive margins" figure grouped among "low rates" statistics). Reported on Colorectal Polyps and Local Excision of Rectal Neoplasms exactly as extracted, flagged as a likely transcription/printing anomaly rather than silently corrected.

Relevance

Twenty-third entry in the ASCRS ingest, fourth chapter of Part III ("Malignant Disease"). A second consecutive reconciliation-heavy chapter (after Ch22) — its main contribution is resolving a previously-flagged cross-page consistency gap on Endoscopic Polypectomy, EMR & ESD and giving Colorectal Polyps's malignant-polyp content the quantitative depth/risk-factor grounding it previously lacked, rather than introducing an entirely new topic.