Modern approach in the management of malignant colorectal polyp

Malignant colorectal polyp refers to the polyp in which the neoplastic lesion invades into but not beyond the submucosa. The morphological features and surface patterns of the malignant polyps are examined by the white-light and image-enhanced endoscopy, which help to predict the depth of invasion of neoplastic lesions. The deep submucosal invasion is associated with a high risk of residual cancer and lymph node metastasis. The image-enhanced endoscopy is useful in identifying the malignant polyp amenable for endoscopic resection or require formal oncological surgery. After the endoscopic resection of the polyp, the thorough histopathological assessment is required to determine the possibility of residual tumor, recurrence, and lymph node involvement. The presence of high-risk features (deep submucosal invasion, poor differentiation, lymphovascular invasion, <1 mm resection margin, piecemeal resection, and tumor budding) indicates a need for surgical resection with lymph node clearance. In low-risk cases, the endoscopic resection is considered adequate and further surveillance is advised. The final decision about the endoscopic resection versus surgical resection of malignant polyp needs to be individualized and should be based not only on polyp related characteristics but also on comorbidities, local resources, expertise availability, and patient’s preference.