Can Endoscopic Resection Alone Provide Definitive Management for High-Risk Adenomatous Polyps?

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M. Ozdemir, M. Guler, R. Kucukarslan Guler, D. Ogutmen Koc, Z. Pelen, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9322957/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Objective Adenomatous polyps with high-grade dysplasia or intramucosal carcinoma are generally managed endoscopically, while lesions with deeper invasion typically require radical resection. This study aimed to provide clinically relevant information to support colorectal cancer prevention by examining the relationships among demographic, clinical, and histopathological features and performing risk stratification of patients with detected high-risk polyps. Methods This retrospective multicenter study included 128 patients with high-risk adenomatous polyps treated between January 2006 and September 2025 at two tertiary referral centers. Patients were categorized according to polyp morphology as sessile, pedunculated, or mixed-morphology. Clinicopathological characteristics, treatment modalities, and follow-up data were analyzed. High-risk polyps were defined according to histopathological features associated with advanced neoplasia and potential residual disease risk. Results Of the 128 patients, 55 (43.0%) had sessile, 49 (38.3%) had pedunculated, and 24 (18.8%) had mixed high-risk polyps. Age, maximum polyp size, follow-up duration, and sex distribution were comparable across the three groups, whereas rectal location, excision technique, en bloc resection, and piecemeal resection differed significantly according to polyp morphology. In multivariable analysis, positive resection margin was the only independent factor associated with radical surgery, whereas piecemeal resection, invasive adenocarcinoma histology, and rectal location were independently associated with margin positivity. No local recurrence or distant metastasis occurred during follow-up. Conclusions High-risk adenomatous polyps can be safely managed without radical surgery if complete en bloc excision and low-risk pathological features are present. Under close surveillance, minimally invasive endoscopic procedures offer effective treatment for selected patients. High-risk adenomatous polyps Endoscopic resection Colorectal cancer prevention En bloc excision Polyp morphology Introduction Although colorectal cancer (CRC) is considered preventable, it remains the second leading cause of cancer-related death worldwide, with an estimated lifetime risk of approximately 4% to 5% ( 1 ). In the 1960s, Gilbertson proposed that colorectal cancer develops through intermediate precursor stages ( 2 ), and in the following decade, Fearon and Vogelstein characterized the genetic pathways of colorectal carcinogenesis, defining the adenoma–carcinoma sequence ( 3 ). These findings highlighted the potential of colorectal cancer screening and colonoscopic removal of precancerous adenomas to substantially reduce CRC burden. Colonoscopic polypectomy has been shown to prevent 76% to 90% of CRC-related morbidity and reduce mortality by up to 53% ( 4 ). The strong association between neoplastic colorectal polyps and colorectal cancer makes polypectomy a cornerstone intervention for interrupting the adenoma–carcinoma sequence and preventing cancer development ( 5 ). High-risk adenomatous polyps are typically defined as adenomas that are three or more in number, larger than 10 mm, or exhibiting villous or tubulovillous architecture, or high-grade dysplasia ( 6 ). Understanding these characteristics is critical for guiding treatment decisions and risk stratification. Among malignant polyps, intramucosal carcinoma (IMC) involves malignant cells invading the lamina propria, while invasive carcinoma extends into the submucosa. High-grade dysplasia (HGD) is confined to architectural and cytologic atypia within the epithelium. Approximately 5% to 7% of adenomas contain HGD, and invasive carcinoma is identified in 3% to 5% of these lesions ( 7 ). Low- and high-grade dysplasia represent a continuum of biological changes, and there is no universally accepted definition of “high-grade.” Generally, HGD denotes pronounced architectural and cytologic abnormalities consistent with in situ neoplasia ( 8 ). Endoscopic polypectomy remains the standard treatment for these lesions. En bloc polypectomy allows accurate histological assessment of both deep and lateral margins. Endoscopic submucosal dissection (ESD) enables comprehensive pathological evaluation and has been associated with lower recurrence rates compared with piecemeal resection ( 9 ). Given these considerations, evaluating polyp morphology, excision technique, and histopathological features is essential for optimizing patient care. In this study, we aimed to define the relationships among demographic, clinical, and histopathological features of patients with high-risk polyps, support risk stratification, and provide clinically applicable data to inform colorectal cancer prevention efforts. Materials and Methods This retrospective multicenter study was conducted at two tertiary referral hospitals. Patients who underwent colonoscopy between January 2006 and September 2025 and were found to have colorectal polyps were identified through the electronic medical record systems of the participating institutions. Among these patients, those with high-risk adenomatous polyps confirmed by histopathological evaluation after endoscopic or local excision were included in the study. Polyps containing high-grade dysplasia, intramucosal carcinoma, or invasive carcinoma were managed according to the treatment algorithm described by James M. Church ( 9 ). In this approach, lesions with high-grade dysplasia were treated locally by snare polypectomy, endoscopic submucosal dissection, or transanal endoscopic microsurgery, followed by surveillance at 3- to 6-month intervals. In patients with invasive carcinoma, surveillance without radical surgery was considered appropriate only when all favorable histopathological criteria were present, including Haggitt level 1 or 2 invasion, a clear resection margin of at least 2 mm, well- or moderately differentiated histology, and absence of lymphovascular invasion. Patients with any unfavorable pathological feature beyond these criteria were referred for radical surgery. High-risk adenomatous polyps were defined as adenomatous lesions with one or more advanced features, including size ≥ 10 mm, villous or tubulovillous histology, high-grade dysplasia, intramucosal carcinoma, or invasive carcinoma. Clinical and pathological variables, including age, polyp location, number of polyps, histopathological diagnosis, type of endoscopic or local excision, need for radical surgery, and follow-up duration, were obtained from the medical records. Patients younger than 18 years and those in whom complete removal could not be achieved by endoscopic or local minimally invasive techniques were excluded. The primary outcome was the need for additional radical surgery after endoscopic or local excision. Secondary outcomes included positive resection margin status, histopathological diagnosis, recurrence during follow-up, and distant metastasis. Ethics committee approval was obtained before study initiation. The study was conducted in accordance with the Declaration of Helsinki and was designed and reported in compliance with the STROBE statement. Statistical Analysis All statistical analyses were performed using IBM SPSS Statistics for Mac, version 27.0 (IBM Corp., Armonk, NY, USA). Continuous variables were expressed as mean ± standard deviation or median (interquartile range), depending on data distribution, whereas categorical variables were presented as number and percentage. Comparisons among polyp morphology groups were performed using the Kruskal–Wallis test for continuous variables and the chi-square test for categorical variables. When expected cell counts were low, Fisher’s exact test was used, as appropriate. For two-group comparisons involving continuous variables, the Mann–Whitney U test was applied. Variables associated with positive resection margins in univariable analyses, together with clinically relevant covariates, were further evaluated using multivariable binary logistic regression analysis. Additional multivariable logistic regression models were constructed to assess factors associated with radical surgery. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Model calibration was assessed using the Hosmer–Lemeshow goodness-of-fit test. A two-sided p value of < 0.05 was considered statistically significant. Results Of the 128 patients included, 55 (43.0%) had sessile, 49 (38.3%) had pedunculated, and 24 (18.8%) had mixed-morphology high-risk polyps. Age, maximum polyp size, follow-up duration, and sex distribution were similar among the three groups (p = 0.693, p = 0.212, p = 0.313, and p = 0.593, respectively) (Table 1 ). In contrast, lesion location, excision method, en bloc resection, and piecemeal resection differed significantly according to polyp morphology (p = 0.004, p = 0.008, p = 0.001, and p = 0.003, respectively). Complication rates were low and did not differ between the groups (p = 0.656) (Table 2 ). Table 1 Baseline demographic and clinical characteristics according to polyp type Variable Sessile (n = 55) Pedunculated (n = 49) Mixed (n = 24) Total (n = 128) p value Age, years 63 ( 13 ) 66.5 ( 13 ) 66 ( 8 ) 65 ( 13 ) 0.693 Maximum polyp size, mm 20 ( 10 ) 20 ( 10 ) 15 ( 15 ) 20 ( 10 ) 0.212 Follow-up duration year 5 ( 5 ) 5 ( 6 ) 3 ( 2 ) 4 ( 5 ) 0.313 Female sex, n (%) 27 (49.1) 20 (40.8) 9 (37.5) 56 (43.8) 0.593 Male sex, n (%) 28 (50.9) 29 (59.2) 15 (62.5) 72 (56.3) Table 2 Lesion localization and procedural characteristics according to polyp type Variable Sessile (n = 55) Pedunculated (n = 49) Mixed(n = 24) Total (n = 128) p value Localization , n (%) 0.004 Rectum 29 (52.7) 9 (18.4) 6 (25.0) 44 (34.4) Sigmoid colon 16 (29.1) 24 (49.0) 9 (37.5) 49 (38.3) Left colon 6 (10.9) 5 (10.2) 1 (4.2) 12 (9.4) Transverse colon 0 (0.0) 1 (2.0) 0 (0.0) 1 (0.8) Right colon 4 (7.3) 10 (20.4) 8 (33.3) 22 (17.2) Excision type , n (%) 0.008 EMR 1 (1.8) 2 (4.1) 1 (4.2) 4 (3.1) ESD 26 (47.3) 11 (22.4) 9 (37.5) 46 (35.9) TEMS 7 (12.7) 1 (2.0) 0 (0.0) 8 (6.3) Transanal excision 0 (0.0) 1 (2.0) 0 (0.0) 1 (0.8) Snare polypectomy 21 (38.2) 34 (69.4) 14 (58.3) 69 (53.9) En bloc resection , n (%) 0.001 No 44 (80.0) 49 (100.0) 20 (83.3) 113 (88.3) Yes 11 (20.0) 0 (0.0) 4 (16.7) 15 (11.7) Piecemeal resection , n (%) 0.003 No 45 (81.8) 49 (100.0) 21 (87.5) 115 (89.8) Yes 10 (18.2) 0 (0.0) 3 (12.5) 13 (10.2) Complication , n (%) 0.656 None 53 (96.4) 48 (100.0) 23 (95.8) 124 (97.6) Bleeding 1 (1.8) 0 (0.0) 1 (4.2) 2 (1.6) Perforation 1 (1.8) 0 (0.0) 0 (0.0) 1 (0.8) Histopathological findings also varied by polyp type. Positive resection margins were identified in 30 patients (23.4%) and were more frequent in sessile and mixed lesions than in pedunculated lesions (29.1%, 37.5%, and 10.2%, respectively; p = 0.012). Histopathological diagnosis differed significantly across the groups (p < 0.001). High-grade dysplasia was the most common diagnosis overall, whereas intramucosal carcinoma was more common in pedunculated lesions. Invasive adenocarcinoma was detected in 12 patients (9.4%) and was not observed in the pedunculated group. The need for radical surgery also differed significantly by polyp type (p = 0.003), with pedunculated lesions requiring additional surgery less frequently than sessile or mixed lesions (Table 3 ). Table 3 Histopathological findings and surgical outcomes according to polyp type Variable Sessile (n = 55) Pedunculated (n = 49) Mixed(n = 24) Total (n = 128) p value Positive resection margin , n (%) 0.012 Negative 39 (70.9) 44 (89.8) 15 (62.5) 98 (76.6) Positive 16 (29.1) 5 (10.2) 9 (37.5) 30 (23.4) Histopathological diagnosis , n (%) < 0.001 High-grade dysplasia 31 (56.4) 28 (57.1) 10 (41.7) 69 (53.9) Intramucosal carcinoma 6 (10.9) 18 (36.7) 4 (16.7) 28 (21.9) Low-grade dysplasia 10 (18.2) 3 (6.1) 6 (25.0) 19 (14.8) Invasive adenocarcinoma 8 (14.5) 0 (0.0) 4 (16.7) 12 (9.4) Radical surgery , n (%) 0.003 No 38 (69.1) 44 (91.7) 13 (56.5) 95 (75.4) Laparoscopic low anterior resection 13 (23.6) 2 (4.2) 5 (21.7) 20 (15.9) Laparoscopic sigmoid resection 1 (1.8) 0 (0.0) 2 (8.7) 3 (2.4) Open APR 1 (1.8) 0 (0.0) 0 (0.0) 1 (0.8) Right/left hemicolectomy 2 (3.6) 2 (4.2) 3 (13.0) 7 (5.6) Final pathological stage/status , n (%) 0.060 No residual disease / no stage progression 44 (80.0) 47 (95.9) 18 (75.0) 109 (85.2) T1N0 8 (14.5) 2 (4.1) 3 (12.5) 13 (10.2) T1N1 2 (3.6) 0 (0.0) 2 (8.3) 4 (3.1) T1N2 1 (1.8) 0 (0.0) 1 (4.2) 2 (1.6) In the univariate analysis for positive resection margin, age, maximum polyp size, follow-up duration, sex, comorbidity, and ASA class were not associated with margin positivity. By contrast, polyp type (p = 0.010), rectal location (p = 0.004), piecemeal resection (p < 0.001), en bloc resection status (p < 0.001), and invasive pathology (p < 0.001) were significantly associated with a positive margin. Positive margins were observed in 84.6% of piecemeal resections and in 91.7% of lesions with invasive adenocarcinoma. Margin positivity was also higher in rectal lesions than in non-rectal lesions (38.6% vs. 15.5%, p = 0.004)(Table 4 ). Table 4 Association between maximum polyp size and histopathological diagnosis Histopathological diagnosis n Maximum polyp size, median (IQR), mm Maximum polyp size, mean ± SD, mm p value Four-group comparison 0.003 High-grade dysplasia 69 20 ( 5 ) 18.20 ± 7.19 Intramucosal carcinoma 28 25 ( 19 ) 25.71 ± 11.11 Intraepithelial neoplasia 19 25 ( 15 ) 20.53 ± 9.17 Invasive adenocarcinoma 12 20 ( 12 ) 21.83 ± 9.43 Two-group comparison 0.700 Non-invasive group 116 20 ( 10 ) 20.40 ± 9.08 Invasive adenocarcinoma 12 20 ( 12 ) 21.83 ± 9.43 In the multivariable logistic regression model, piecemeal resection, invasive adenocarcinoma, and rectal location remained independently associated with positive resection margin status (OR 11.956, 95% CI 1.501–95.198, p = 0.019; OR 13.752, 95% CI 1.190–158.957, p = 0.036; and OR 3.516, 95% CI 1.140–10.846, p = 0.029, respectively). After adjustment, polyp type was no longer independently associated with margin positivity (overall p = 0.162). Model calibration was acceptable according to the Hosmer-Lemeshow test (p = 0.601)(Table 5 ). Table 5 Univariate analysis of factors associated with positive resection margins (Continuous variables are presented as median (IQR) and were compared using the Mann–Whitney U test. Categorical variables are presented as n (%) and were compared using the chi-square test or Fisher’s exact test as appropriate.) Variable Negative margin (n = 98) Positive margin (n = 30) p value Age, median (IQR), years 65.5 ( 12 ) 64.5 ( 12 ) 0.127 Maximum polyp size, median (IQR), mm 20 ( 10 ) 20 ( 15 ) 0.117 Follow-up duration, median (IQR) 4 ( 5 ) 5 ( 4 ) 0.389 Sex, n (%) 1.000 Female 43 (43.9) 13 (43.3) Male 55 (56.1) 17 (56.7) Comorbidity, n (%) 0.140 Absent 34 (34.7) 15 (50.0) Present 64 (65.3) 15 (50.0) ASA class, n (%) 0.658 ASA 1–2 67 (68.4) 22 (73.3) ASA 3–4 31 (31.6) 8 (26.7) Polyp type, n (%) 0.010 Sessile 39 (39.8) 16 (53.3) Pedunculated 44 (44.9) 5 (16.7) Mixed-morphology 15 (15.3) 9 (30.0) Location, n (%) 0.004 Rectum 27 (27.6) 17 (56.7) Other locations 71 (72.4) 13 (43.3) Excision type, n (%) 0.094 EMR 4 (4.1) 0 (0.0) ESD 31 (31.6) 15 (50.0) TEMS 6 (6.1) 2 (6.7) Transanal excision 0 (0.0) 1 (3.3) Snare polypectomy 57 (58.2) 12 (40.0) Piecemeal resection, n (%) < 0.001 No 96 (98.0) 19 (63.3) Yes 2 (2.0) 11 (36.7) En bloc resection, n (%) < 0.001 No 96 (98.0) 17 (56.7) Yes 2 (2.0) 13 (43.3) Pathology group, n (%) < 0.001 Non-invasive group 97 (99.0) 19 (63.3) Invasive adenocarcinoma 1 (1.0) 11 (36.7) Table 6 Multivariable logistic regression analysis for factors associated with positive resection margins Variable B SE Wald OR (Exp[B]) 95% CI for OR p value Polyp type 3.643 0.162 Pedunculated (vs sessile) -0.006 0.672 0.000 0.994 0.266–3.709 0.993 Mixed(vs sessile) 1.204 0.721 2.794 3.335 0.812–13.691 0.095 Piecemeal resection (yes) 2.481 1.059 5.494 11.956 1.501–95.198 0.019 Invasive adenocarcinoma 2.621 1.249 4.406 13.752 1.190–158.957 0.036 Rectal location 1.257 0.575 4.784 3.516 1.140–10.846 0.029 Constant -2.505 0.590 18.057 0.082 < 0.001 Because the main objective of the study was to assess the oncologic adequacy of minimally invasive treatment, additional analyses were performed for radical surgery. In the adjusted model including margin status, positive resection margin was the only independent factor associated with radical surgery (OR 207.599, 95% CI 28.686–1502.406, p < 0.001). In a second model excluding margin status, polyp type remained significant overall (p = 0.020), while invasive adenocarcinoma and piecemeal resection were independently associated with radical surgery (OR 12.151, 95% CI 1.111–132.874, p = 0.041; and OR 8.279, 95% CI 1.048–65.375, p = 0.045, respectively). Rectal location and maximum polyp size were not independently associated with radical surgery in this model. Discussion In this retrospective multicenter study, the main findings were that positive resection margin was the only independent factor associated with additional radical surgery, whereas piecemeal resection, invasive adenocarcinoma histology, and rectal location were independently associated with margin positivity. In addition, pedunculated lesions were less likely to require further surgery than sessile or mixed-morphology lesions. The primary aim of screening programs implemented in accordance with widely accepted guidelines is to detect malignant polyps at an early stage, eliminate them using minimally invasive approaches, and thereby reduce the incidence of advanced colorectal cancer ( 10 ). During colonoscopy, polyp location, size, and endoscopic appearance provide important clues regarding the underlying pathology and the likelihood of local invasion ( 11 ). Worldwide, the probability of being diagnosed with colorectal cancer is approximately three times higher in individuals older than 65 years than in those aged 50–64 years, and nearly 30 times higher than in those aged 25–49 years ( 12 ). In screening colonoscopy cohorts, adenoma detection rates have also been shown to increase with age, reaching 28.0%, 31.8%, 35.6%, and 44.2% in the 0–44, 45–49, 50–54, and 55–75 year age groups, respectively ( 13 ). In our study, high-risk polyps were detected in 9% of patients aged 0–44 years, 20% of those aged 45–55 years, and 71% of those older than 56 years. Consistent with the literature, these findings suggest that the detection rate of high-risk lesions increases with age ( 12 , 13 ). Retrospective studies have reported poorer overall survival in advanced-stage colon cancers located proximal to the splenic flexure ( 14 ). According to data from the National Cancer Database (NCDB), overall survival was also suggested to be worse for proximally located malignant polyps (pT1) removed endoscopically compared with distally located malignant polyps ( 15 ). However, Mochizuki et al. reported a higher rate of lymph node metastasis after excision of distal malignant polyps (pT1), suggesting that these lesions may have more aggressive biological behavior and should therefore be approached more cautiously when planning radical resection ( 16 ). In our study, the significant association between positive resection margins and rectal location, together with the fact that 15 of 16 radical resections after endoscopic treatment were performed for polyps located distal to the splenic flexure, and that nodal disease was identified as N2 in one patient and N1 in another, indicate that particular caution may be warranted when planning treatment for distal colorectal polyps. Polyp size is directly associated with an increased risk of carcinoma. Most detected polyps are diminutive (< 5 mm) or small (6–9 mm) and generally have low malignant potential. In contrast, 22.9% of lesions larger than 10 mm and 60% of lesions larger than 30 mm have been reported to harbor advanced pathology ( 17 ). In another study, the frequency of high-risk adenomatous polyps was 18.9% in lesions measuring 10–14 mm, 31.7% in those measuring 15–19 mm, 42.3% in those measuring 20–24 mm, and 75% in lesions ≥ 25 mm ( 18 ). In our cohort, the maximum polyp size differed significantly among the four histopathological groups, and lesions in the intramucosal carcinoma group were significantly larger than those in the high-grade dysplasia group, in keeping with previous reports. Polyp morphology provides important information for estimating the depth of invasion and the risk of malignancy. According to the Paris classification, lesions are categorized as polypoid or non-polypoid based on whether they protrude more than 2.5 mm above the surrounding mucosa. Polypoid lesions are further classified as pedunculated (0-Ip) or sessile (0-Is) according to the thickness of the lesion base. Non-polypoid lesions are subclassified as slightly elevated (0-IIa), flat (0-IIb), slightly depressed (0-IIc), or excavated (0-III). Non-polypoid lesions are associated with a higher likelihood of harboring high-grade dysplasia than polypoid lesions. The reported risks of submucosal invasion for 0-Ip, 0-Is, 0-IIa, 0-IIb, and 0-IIc lesions are 5%, 34%, 4%, 0%, and 61%, respectively ( 19 ). In our study, sessile polyps contained high-grade dysplasia in 56.4% of cases, intramucosal carcinoma in 10.9%, and invasive carcinoma in 14.5%, and the association between polyp type and histopathological diagnosis was statistically significant. The finding that the need for radical surgery differed significantly according to polyp type, with pedunculated lesions less frequently requiring additional surgery than sessile or mixed-morphology lesions, is consistent with the existing literature ( 20 ). The width of the clearance margin between carcinoma and the resection edge at the polypectomy site is an important histological risk factor for both lymph node metastasis and recurrence in malignant polyps, regardless of whether they are pedunculated or sessile. Butte et al. reported the outcomes of 147 patients who underwent endoscopic mucosal resection followed by surgical resection and found that margin positivity after polypectomy was significantly associated with residual malignancy: residual disease was identified in 16% of patients when the margin was < 1 mm and in 21% of cases when margin status was indeterminate, whereas no residual disease was detected when the resection margin was ≥ 1 mm ( 21 ). In our study, treatment planning was based on a target resection margin greater than 2 mm. Among five patients with macroscopically sessile lesions treated by snare polypectomy who had positive margins but no other adverse risk features, re-excision by transanal endoscopic microsurgery achieved negative margins, and these patients were subsequently included in the surveillance group. In the adjusted model that included resection margin status, a positive resection margin was the only independent factor associated with radical surgery. The high rates of margin positivity observed after piecemeal resection (84.6%), in lesions with invasive adenocarcinoma (91.7%), and in rectal lesions compared with non-rectal lesions highlight key factors that should be taken into consideration when selecting minimally invasive treatment strategies. Meta-analyses have shown that tumor differentiation grade and the presence of lymphovascular invasion are independent risk factors for lymph node metastasis in malignant colorectal polyps ( 22 ). Consistent with the literature, radical surgery was preferred in 16 patients in our cohort because postoperative pathological evaluation after endoscopic resection demonstrated poor differentiation and/or lymphovascular invasion, both of which were considered indicative of increased lymph node metastasis risk. The findings of the present study should be interpreted in light of several limitations. First, the retrospective design introduces the possibility of selection bias and limits control over confounding variables. Second, despite the inclusion of patients from two centers over a long study period, the sample size remained relatively limited, particularly in subgroup analyses. Third, treatment decisions were based not only on lesion pathology but also on technical feasibility, anatomical location, and multidisciplinary clinical judgment, all of which may have influenced outcomes. Finally, the study focused primarily on clinicopathological associations and treatment patterns rather than on long-term oncologic endpoints derived from a standardized surveillance protocol. These limitations should be considered when generalizing the results. Conclusions In conclusion, minimally invasive organ-preserving approaches, including snare polypectomy, endoscopic submucosal dissection, and transanal endoscopic microsurgery, may represent safe and effective treatment options for selected patients with high-risk adenomatous polyps. When complete excision is achieved and favorable pathological features are present, particularly negative resection margins, absence of lymphovascular invasion, and well or moderately differentiated histology, surveillance without radical surgery may be an appropriate management strategy. Conversely, positive margins, piecemeal resection, rectal location, invasive adenocarcinoma, poor differentiation, and lymphovascular invasion should alert clinicians to the increased likelihood that additional radical surgery will be required. Declarations Ethics Committee Approval This retrospective multicenter study was approved by the Clinical Research Ethics Committee of Gaziosmanpaşa Training and Research Hospital (approval no: [90], date: [28.05.2020]). The study was conducted in accordance with the ethical principles of the Helsinki Declaration. Informed Consent Written informed consent was obtained from all participants/patients. Conflicts of Interest and Source of Funding: The authors declare that they have no conflict of interest. This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Acknowledgments The authors have no acknowledgments to declare. Author Contributions Concept: [DG]; Design: [MÖ]; Data Collection and/or Processing: [DG, MÖ]; Analysis and/or Interpretation: [MG, RKG]; Literature Search: [MÖ]; Writing Manuscript: [MÖ, DG]; Critical Review: [MÖ, DG]; Final Approval: All authors. Data Availability Statement The data supporting the findings of this study are available from the corresponding author upon reasonable request. References Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021;71(3):209–49. Gilbertsen VA, Knatterud GL, Lober PH, et al. Invasive carcinoma of the large intestine: A preventable disease? 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Gut. 2006;55:1592–1597. doi: 10.1136/gut.2005.087452. Butte J.M. Tang P. Gonen M. et. Al. Rate of residual disease after complete endoscopic resection of malignant colonic polyp. Dis Colon Rectum 2012; 55: pp. 122-127. Shaukat A, Kaltenbach T, Dominitz JA, Robertson DJ, Anderson JC, Cruise M, Burke CA, Gupta S, Lieberman D, Syngal S, Rex DK. Endoscopic Recognition and Management Strategies for Malignant Colorectal Polyps: Recommendations of the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2020 Nov;159(5):1916-1934.e2. doi: 10.1053/j.gastro.2020.08.050. Epub 2020 Nov 4. PMID: 33159840. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 10 Apr, 2026 Editor assigned by journal 08 Apr, 2026 Submission checks completed at journal 08 Apr, 2026 First submitted to journal 04 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9322957","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":623228878,"identity":"c1bd0084-6d88-4984-8d0d-37daa5783c56","order_by":0,"name":"M. Ozdemir","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFklEQVRIie3QsUoDMRjA8chBbvlyXXPcPcQdBzoI9kFcCgGnRBwVCxUKuhRdW+hDVISsehzUwehc+BZroZOCXRyLuXNwaK/UzSF/MiQhv+MSQlyu/9gDId7PrEUIlMPvVUsItidgql2g2xJCuKx2SR0J8OkoOmnrw4Yvis/3Ux3vDT7y2UIexJR407fJKglflI76Y1SD3ryVDg1CjMciybWwP0azTK6SxDAdAUU1mshEsEsEHsldnmvPEqBRLVmiurekYEtLQlOSzmZiP65GXKZddmEJh5IUtSQ07G6fXaPqm7nYGY4tAZklz/oRqLf+LoFhtwhfqG6uyhdrY5P7Jn090+fNht+dztaQTXl/O+5yuVyu374Bouhl0O8wdz0AAAAASUVORK5CYII=","orcid":"","institution":"Gaziosmanpaşa Eğitim Ve Araştırma Hastanesi, General Surgery Clinic","correspondingAuthor":true,"prefix":"","firstName":"M.","middleName":"","lastName":"Ozdemir","suffix":""},{"id":623228879,"identity":"c4aa6a8c-db3b-4718-b8d8-087de0923d82","order_by":1,"name":"M. Guler","email":"","orcid":"","institution":"Gaziosmanpaşa Eğitim Ve Araştırma Hastanesi, General Surgery Clinic","correspondingAuthor":false,"prefix":"","firstName":"M.","middleName":"","lastName":"Guler","suffix":""},{"id":623228880,"identity":"39f926d3-d238-4c7a-8787-6827127f9a5c","order_by":2,"name":"R. Kucukarslan Guler","email":"","orcid":"","institution":"Gaziosmanpaşa Eğitim Ve Araştırma Hastanesi, General Surgery Clinic","correspondingAuthor":false,"prefix":"","firstName":"R.","middleName":"Kucukarslan","lastName":"Guler","suffix":""},{"id":623228882,"identity":"b2a1538a-1a2c-477d-9669-da4e70bf9a27","order_by":3,"name":"D. Ogutmen Koc","email":"","orcid":"","institution":"Gaziosmanpaşa Eğitim Ve Araştırma Hastanesi, Gastroenterology Department","correspondingAuthor":false,"prefix":"","firstName":"D.","middleName":"Ogutmen","lastName":"Koc","suffix":""},{"id":623228883,"identity":"dd4de888-9879-48d4-bb36-ad5305aad8cf","order_by":4,"name":"Z. Pelen","email":"","orcid":"","institution":"Gaziosmanpaşa Eğitim Ve Araştırma Hastanesi, General Surgery Clinic","correspondingAuthor":false,"prefix":"","firstName":"Z.","middleName":"","lastName":"Pelen","suffix":""},{"id":623228885,"identity":"757eea14-57be-4244-82b8-da2a7c496c1c","order_by":5,"name":"D. Gonullu","email":"","orcid":"","institution":"Gaziosmanpaşa Eğitim Ve Araştırma Hastanesi, General Surgery Clinic","correspondingAuthor":false,"prefix":"","firstName":"D.","middleName":"","lastName":"Gonullu","suffix":""}],"badges":[],"createdAt":"2026-04-04 21:08:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9322957/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9322957/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107483527,"identity":"d6dda70b-00fa-4cad-b3a0-3059bd59da30","added_by":"auto","created_at":"2026-04-22 02:28:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":808307,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9322957/v1/0f00cdfc-6b68-40bb-845e-65c41d0ecbb3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Can Endoscopic Resection Alone Provide Definitive Management for High-Risk Adenomatous Polyps?","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAlthough colorectal cancer (CRC) is considered preventable, it remains the second leading cause of cancer-related death worldwide, with an estimated lifetime risk of approximately 4% to 5% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In the 1960s, Gilbertson proposed that colorectal cancer develops through intermediate precursor stages (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), and in the following decade, Fearon and Vogelstein characterized the genetic pathways of colorectal carcinogenesis, defining the adenoma\u0026ndash;carcinoma sequence (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). These findings highlighted the potential of colorectal cancer screening and colonoscopic removal of precancerous adenomas to substantially reduce CRC burden. Colonoscopic polypectomy has been shown to prevent 76% to 90% of CRC-related morbidity and reduce mortality by up to 53% (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe strong association between neoplastic colorectal polyps and colorectal cancer makes polypectomy a cornerstone intervention for interrupting the adenoma\u0026ndash;carcinoma sequence and preventing cancer development (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). High-risk adenomatous polyps are typically defined as adenomas that are three or more in number, larger than 10 mm, or exhibiting villous or tubulovillous architecture, or high-grade dysplasia (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Understanding these characteristics is critical for guiding treatment decisions and risk stratification.\u003c/p\u003e \u003cp\u003eAmong malignant polyps, intramucosal carcinoma (IMC) involves malignant cells invading the lamina propria, while invasive carcinoma extends into the submucosa. High-grade dysplasia (HGD) is confined to architectural and cytologic atypia within the epithelium. Approximately 5% to 7% of adenomas contain HGD, and invasive carcinoma is identified in 3% to 5% of these lesions (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Low- and high-grade dysplasia represent a continuum of biological changes, and there is no universally accepted definition of \u0026ldquo;high-grade.\u0026rdquo; Generally, HGD denotes pronounced architectural and cytologic abnormalities consistent with in situ neoplasia (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Endoscopic polypectomy remains the standard treatment for these lesions.\u003c/p\u003e \u003cp\u003eEn bloc polypectomy allows accurate histological assessment of both deep and lateral margins. Endoscopic submucosal dissection (ESD) enables comprehensive pathological evaluation and has been associated with lower recurrence rates compared with piecemeal resection (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Given these considerations, evaluating polyp morphology, excision technique, and histopathological features is essential for optimizing patient care. In this study, we aimed to define the relationships among demographic, clinical, and histopathological features of patients with high-risk polyps, support risk stratification, and provide clinically applicable data to inform colorectal cancer prevention efforts.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThis retrospective multicenter study was conducted at two tertiary referral hospitals. Patients who underwent colonoscopy between January 2006 and September 2025 and were found to have colorectal polyps were identified through the electronic medical record systems of the participating institutions. Among these patients, those with high-risk adenomatous polyps confirmed by histopathological evaluation after endoscopic or local excision were included in the study.\u003c/p\u003e \u003cp\u003ePolyps containing high-grade dysplasia, intramucosal carcinoma, or invasive carcinoma were managed according to the treatment algorithm described by James M. Church (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). In this approach, lesions with high-grade dysplasia were treated locally by snare polypectomy, endoscopic submucosal dissection, or transanal endoscopic microsurgery, followed by surveillance at 3- to 6-month intervals. In patients with invasive carcinoma, surveillance without radical surgery was considered appropriate only when all favorable histopathological criteria were present, including Haggitt level 1 or 2 invasion, a clear resection margin of at least 2 mm, well- or moderately differentiated histology, and absence of lymphovascular invasion. Patients with any unfavorable pathological feature beyond these criteria were referred for radical surgery. High-risk adenomatous polyps were defined as adenomatous lesions with one or more advanced features, including size\u0026thinsp;\u0026ge;\u0026thinsp;10 mm, villous or tubulovillous histology, high-grade dysplasia, intramucosal carcinoma, or invasive carcinoma.\u003c/p\u003e \u003cp\u003eClinical and pathological variables, including age, polyp location, number of polyps, histopathological diagnosis, type of endoscopic or local excision, need for radical surgery, and follow-up duration, were obtained from the medical records. Patients younger than 18 years and those in whom complete removal could not be achieved by endoscopic or local minimally invasive techniques were excluded. The primary outcome was the need for additional radical surgery after endoscopic or local excision. Secondary outcomes included positive resection margin status, histopathological diagnosis, recurrence during follow-up, and distant metastasis. Ethics committee approval was obtained before study initiation. The study was conducted in accordance with the Declaration of Helsinki and was designed and reported in compliance with the STROBE statement.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eAll statistical analyses were performed using IBM SPSS Statistics for Mac, version 27.0 (IBM Corp., Armonk, NY, USA). Continuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or median (interquartile range), depending on data distribution, whereas categorical variables were presented as number and percentage. Comparisons among polyp morphology groups were performed using the Kruskal\u0026ndash;Wallis test for continuous variables and the chi-square test for categorical variables. When expected cell counts were low, Fisher\u0026rsquo;s exact test was used, as appropriate. For two-group comparisons involving continuous variables, the Mann\u0026ndash;Whitney U test was applied.\u003c/p\u003e \u003cp\u003eVariables associated with positive resection margins in univariable analyses, together with clinically relevant covariates, were further evaluated using multivariable binary logistic regression analysis. Additional multivariable logistic regression models were constructed to assess factors associated with radical surgery. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Model calibration was assessed using the Hosmer\u0026ndash;Lemeshow goodness-of-fit test. A two-sided p value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eOf the 128 patients included, 55 (43.0%) had sessile, 49 (38.3%) had pedunculated, and 24 (18.8%) had mixed-morphology high-risk polyps. Age, maximum polyp size, follow-up duration, and sex distribution were similar among the three groups (p\u0026thinsp;=\u0026thinsp;0.693, p\u0026thinsp;=\u0026thinsp;0.212, p\u0026thinsp;=\u0026thinsp;0.313, and p\u0026thinsp;=\u0026thinsp;0.593, respectively) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In contrast, lesion location, excision method, en bloc resection, and piecemeal resection differed significantly according to polyp morphology (p\u0026thinsp;=\u0026thinsp;0.004, p\u0026thinsp;=\u0026thinsp;0.008, p\u0026thinsp;=\u0026thinsp;0.001, and p\u0026thinsp;=\u0026thinsp;0.003, respectively). Complication rates were low and did not differ between the groups (p\u0026thinsp;=\u0026thinsp;0.656) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline demographic and clinical characteristics according to polyp type\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSessile (n\u0026thinsp;=\u0026thinsp;55)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePedunculated (n\u0026thinsp;=\u0026thinsp;49)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMixed (n\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;128)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63 (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.5 (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66 (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e65 (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.693\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaximum polyp size, mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20 (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.212\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFollow-up duration year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.313\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale sex, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (49.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (40.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e56 (43.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.593\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale sex, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (50.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (59.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e72 (56.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLesion localization and procedural characteristics according to polyp type\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSessile (n\u0026thinsp;=\u0026thinsp;55)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePedunculated (n\u0026thinsp;=\u0026thinsp;49)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMixed(n\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;128)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLocalization\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRectum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29 (52.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (18.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e44 (34.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSigmoid colon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16 (29.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24 (49.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e49 (38.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft colon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (10.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (10.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12 (9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransverse colon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight colon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (7.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (20.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e22 (17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExcision type\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEMR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eESD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26 (47.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (22.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e46 (35.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTEMS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (12.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8 (6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransanal excision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSnare polypectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21 (38.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34 (69.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14 (58.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e69 (53.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEn bloc resection\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44 (80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20 (83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e113 (88.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e15 (11.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePiecemeal resection\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45 (81.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21 (87.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e115 (89.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13 (10.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComplication\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.656\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53 (96.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23 (95.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e124 (97.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBleeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerforation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eHistopathological findings also varied by polyp type. Positive resection margins were identified in 30 patients (23.4%) and were more frequent in sessile and mixed lesions than in pedunculated lesions (29.1%, 37.5%, and 10.2%, respectively; p\u0026thinsp;=\u0026thinsp;0.012). Histopathological diagnosis differed significantly across the groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). High-grade dysplasia was the most common diagnosis overall, whereas intramucosal carcinoma was more common in pedunculated lesions. Invasive adenocarcinoma was detected in 12 patients (9.4%) and was not observed in the pedunculated group. The need for radical surgery also differed significantly by polyp type (p\u0026thinsp;=\u0026thinsp;0.003), with pedunculated lesions requiring additional surgery less frequently than sessile or mixed lesions (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHistopathological findings and surgical outcomes according to polyp type\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSessile (n\u0026thinsp;=\u0026thinsp;55)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePedunculated (n\u0026thinsp;=\u0026thinsp;49)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMixed(n\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;128)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePositive resection margin\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39 (70.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44 (89.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15 (62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e98 (76.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16 (29.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (10.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e30 (23.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHistopathological diagnosis\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh-grade dysplasia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31 (56.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28 (57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10 (41.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e69 (53.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntramucosal carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (10.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18 (36.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e28 (21.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow-grade dysplasia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e19 (14.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInvasive adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (14.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12 (9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRadical surgery\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38 (69.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44 (91.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13 (56.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e95 (75.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaparoscopic low anterior resection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13 (23.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5 (21.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e20 (15.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaparoscopic sigmoid resection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 (8.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOpen APR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight/left hemicolectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3 (13.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7 (5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFinal pathological stage/status\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.060\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo residual disease / no stage progression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44 (80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47 (95.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18 (75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e109 (85.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT1N0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (14.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13 (10.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT1N1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT1N2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the univariate analysis for positive resection margin, age, maximum polyp size, follow-up duration, sex, comorbidity, and ASA class were not associated with margin positivity. By contrast, polyp type (p\u0026thinsp;=\u0026thinsp;0.010), rectal location (p\u0026thinsp;=\u0026thinsp;0.004), piecemeal resection (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), en bloc resection status (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and invasive pathology (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were significantly associated with a positive margin. Positive margins were observed in 84.6% of piecemeal resections and in 91.7% of lesions with invasive adenocarcinoma. Margin positivity was also higher in rectal lesions than in non-rectal lesions (38.6% vs. 15.5%, p\u0026thinsp;=\u0026thinsp;0.004)(Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation between maximum polyp size and histopathological diagnosis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistopathological diagnosis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMaximum polyp size, median (IQR), mm\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMaximum polyp size, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, mm\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFour-group comparison\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh-grade dysplasia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e18.20\u0026thinsp;\u0026plusmn;\u0026thinsp;7.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntramucosal carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e25.71\u0026thinsp;\u0026plusmn;\u0026thinsp;11.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraepithelial neoplasia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e20.53\u0026thinsp;\u0026plusmn;\u0026thinsp;9.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInvasive adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e21.83\u0026thinsp;\u0026plusmn;\u0026thinsp;9.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTwo-group comparison\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.700\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-invasive group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e20.40\u0026thinsp;\u0026plusmn;\u0026thinsp;9.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInvasive adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e21.83\u0026thinsp;\u0026plusmn;\u0026thinsp;9.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the multivariable logistic regression model, piecemeal resection, invasive adenocarcinoma, and rectal location remained independently associated with positive resection margin status (OR 11.956, 95% CI 1.501\u0026ndash;95.198, p\u0026thinsp;=\u0026thinsp;0.019; OR 13.752, 95% CI 1.190\u0026ndash;158.957, p\u0026thinsp;=\u0026thinsp;0.036; and OR 3.516, 95% CI 1.140\u0026ndash;10.846, p\u0026thinsp;=\u0026thinsp;0.029, respectively). After adjustment, polyp type was no longer independently associated with margin positivity (overall p\u0026thinsp;=\u0026thinsp;0.162). Model calibration was acceptable according to the Hosmer-Lemeshow test (p\u0026thinsp;=\u0026thinsp;0.601)(Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate analysis of factors associated with positive resection margins (Continuous variables are presented as median (IQR) and were compared using the Mann\u0026ndash;Whitney U test. Categorical variables are presented as n (%) and were compared using the chi-square test or Fisher\u0026rsquo;s exact test as appropriate.)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNegative margin (n\u0026thinsp;=\u0026thinsp;98)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePositive margin (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge, median (IQR), years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65.5 (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64.5 (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.127\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMaximum polyp size, median (IQR), mm\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.117\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFollow-up duration, median (IQR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.389\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43 (43.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (43.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55 (56.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (56.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComorbidity, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.140\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbsent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (34.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64 (65.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eASA class, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.658\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA 1\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67 (68.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (73.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA 3\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (31.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (26.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePolyp type, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSessile\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39 (39.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (53.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePedunculated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (44.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMixed-morphology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (15.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLocation, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRectum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (27.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (56.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther locations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71 (72.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (43.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExcision type, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEMR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eESD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (31.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTEMS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransanal excision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSnare polypectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57 (58.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (40.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePiecemeal resection, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e96 (98.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (63.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (36.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEn bloc resection, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e96 (98.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (56.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (43.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePathology group, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-invasive group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97 (99.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (63.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInvasive adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (36.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariable logistic regression analysis for factors associated with positive resection margins\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWald\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR (Exp[B])\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI for OR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePolyp type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.643\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.162\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePedunculated (vs sessile)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.672\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.994\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.266\u0026ndash;3.709\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.993\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMixed(vs sessile)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.721\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.794\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.335\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.812\u0026ndash;13.691\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.095\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePiecemeal resection (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.481\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.059\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.494\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11.956\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.501\u0026ndash;95.198\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.019\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInvasive adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.621\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.249\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.406\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13.752\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.190\u0026ndash;158.957\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.036\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRectal location\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.575\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.784\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.516\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.140\u0026ndash;10.846\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.029\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-2.505\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.590\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.082\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBecause the main objective of the study was to assess the oncologic adequacy of minimally invasive treatment, additional analyses were performed for radical surgery. In the adjusted model including margin status, positive resection margin was the only independent factor associated with radical surgery (OR 207.599, 95% CI 28.686\u0026ndash;1502.406, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In a second model excluding margin status, polyp type remained significant overall (p\u0026thinsp;=\u0026thinsp;0.020), while invasive adenocarcinoma and piecemeal resection were independently associated with radical surgery (OR 12.151, 95% CI 1.111\u0026ndash;132.874, p\u0026thinsp;=\u0026thinsp;0.041; and OR 8.279, 95% CI 1.048\u0026ndash;65.375, p\u0026thinsp;=\u0026thinsp;0.045, respectively). Rectal location and maximum polyp size were not independently associated with radical surgery in this model.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this retrospective multicenter study, the main findings were that positive resection margin was the only independent factor associated with additional radical surgery, whereas piecemeal resection, invasive adenocarcinoma histology, and rectal location were independently associated with margin positivity. In addition, pedunculated lesions were less likely to require further surgery than sessile or mixed-morphology lesions.\u003c/p\u003e \u003cp\u003eThe primary aim of screening programs implemented in accordance with widely accepted guidelines is to detect malignant polyps at an early stage, eliminate them using minimally invasive approaches, and thereby reduce the incidence of advanced colorectal cancer (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). During colonoscopy, polyp location, size, and endoscopic appearance provide important clues regarding the underlying pathology and the likelihood of local invasion (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWorldwide, the probability of being diagnosed with colorectal cancer is approximately three times higher in individuals older than 65 years than in those aged 50\u0026ndash;64 years, and nearly 30 times higher than in those aged 25\u0026ndash;49 years (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). In screening colonoscopy cohorts, adenoma detection rates have also been shown to increase with age, reaching 28.0%, 31.8%, 35.6%, and 44.2% in the 0\u0026ndash;44, 45\u0026ndash;49, 50\u0026ndash;54, and 55\u0026ndash;75 year age groups, respectively (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). In our study, high-risk polyps were detected in 9% of patients aged 0\u0026ndash;44 years, 20% of those aged 45\u0026ndash;55 years, and 71% of those older than 56 years. Consistent with the literature, these findings suggest that the detection rate of high-risk lesions increases with age (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRetrospective studies have reported poorer overall survival in advanced-stage colon cancers located proximal to the splenic flexure (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). According to data from the National Cancer Database (NCDB), overall survival was also suggested to be worse for proximally located malignant polyps (pT1) removed endoscopically compared with distally located malignant polyps (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, Mochizuki et al. reported a higher rate of lymph node metastasis after excision of distal malignant polyps (pT1), suggesting that these lesions may have more aggressive biological behavior and should therefore be approached more cautiously when planning radical resection (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). In our study, the significant association between positive resection margins and rectal location, together with the fact that 15 of 16 radical resections after endoscopic treatment were performed for polyps located distal to the splenic flexure, and that nodal disease was identified as N2 in one patient and N1 in another, indicate that particular caution may be warranted when planning treatment for distal colorectal polyps.\u003c/p\u003e \u003cp\u003ePolyp size is directly associated with an increased risk of carcinoma. Most detected polyps are diminutive (\u0026lt;\u0026thinsp;5 mm) or small (6\u0026ndash;9 mm) and generally have low malignant potential. In contrast, 22.9% of lesions larger than 10 mm and 60% of lesions larger than 30 mm have been reported to harbor advanced pathology (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). In another study, the frequency of high-risk adenomatous polyps was 18.9% in lesions measuring 10\u0026ndash;14 mm, 31.7% in those measuring 15\u0026ndash;19 mm, 42.3% in those measuring 20\u0026ndash;24 mm, and 75% in lesions\u0026thinsp;\u0026ge;\u0026thinsp;25 mm (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). In our cohort, the maximum polyp size differed significantly among the four histopathological groups, and lesions in the intramucosal carcinoma group were significantly larger than those in the high-grade dysplasia group, in keeping with previous reports.\u003c/p\u003e \u003cp\u003ePolyp morphology provides important information for estimating the depth of invasion and the risk of malignancy. According to the Paris classification, lesions are categorized as polypoid or non-polypoid based on whether they protrude more than 2.5 mm above the surrounding mucosa. Polypoid lesions are further classified as pedunculated (0-Ip) or sessile (0-Is) according to the thickness of the lesion base. Non-polypoid lesions are subclassified as slightly elevated (0-IIa), flat (0-IIb), slightly depressed (0-IIc), or excavated (0-III). Non-polypoid lesions are associated with a higher likelihood of harboring high-grade dysplasia than polypoid lesions. The reported risks of submucosal invasion for 0-Ip, 0-Is, 0-IIa, 0-IIb, and 0-IIc lesions are 5%, 34%, 4%, 0%, and 61%, respectively (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). In our study, sessile polyps contained high-grade dysplasia in 56.4% of cases, intramucosal carcinoma in 10.9%, and invasive carcinoma in 14.5%, and the association between polyp type and histopathological diagnosis was statistically significant. The finding that the need for radical surgery differed significantly according to polyp type, with pedunculated lesions less frequently requiring additional surgery than sessile or mixed-morphology lesions, is consistent with the existing literature (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe width of the clearance margin between carcinoma and the resection edge at the polypectomy site is an important histological risk factor for both lymph node metastasis and recurrence in malignant polyps, regardless of whether they are pedunculated or sessile. Butte et al. reported the outcomes of 147 patients who underwent endoscopic mucosal resection followed by surgical resection and found that margin positivity after polypectomy was significantly associated with residual malignancy: residual disease was identified in 16% of patients when the margin was \u0026lt;\u0026thinsp;1 mm and in 21% of cases when margin status was indeterminate, whereas no residual disease was detected when the resection margin was \u0026ge;\u0026thinsp;1 mm (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). In our study, treatment planning was based on a target resection margin greater than 2 mm. Among five patients with macroscopically sessile lesions treated by snare polypectomy who had positive margins but no other adverse risk features, re-excision by transanal endoscopic microsurgery achieved negative margins, and these patients were subsequently included in the surveillance group. In the adjusted model that included resection margin status, a positive resection margin was the only independent factor associated with radical surgery. The high rates of margin positivity observed after piecemeal resection (84.6%), in lesions with invasive adenocarcinoma (91.7%), and in rectal lesions compared with non-rectal lesions highlight key factors that should be taken into consideration when selecting minimally invasive treatment strategies. Meta-analyses have shown that tumor differentiation grade and the presence of lymphovascular invasion are independent risk factors for lymph node metastasis in malignant colorectal polyps (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Consistent with the literature, radical surgery was preferred in 16 patients in our cohort because postoperative pathological evaluation after endoscopic resection demonstrated poor differentiation and/or lymphovascular invasion, both of which were considered indicative of increased lymph node metastasis risk.\u003c/p\u003e \u003cp\u003eThe findings of the present study should be interpreted in light of several limitations. First, the retrospective design introduces the possibility of selection bias and limits control over confounding variables. Second, despite the inclusion of patients from two centers over a long study period, the sample size remained relatively limited, particularly in subgroup analyses. Third, treatment decisions were based not only on lesion pathology but also on technical feasibility, anatomical location, and multidisciplinary clinical judgment, all of which may have influenced outcomes. Finally, the study focused primarily on clinicopathological associations and treatment patterns rather than on long-term oncologic endpoints derived from a standardized surveillance protocol. These limitations should be considered when generalizing the results.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, minimally invasive organ-preserving approaches, including snare polypectomy, endoscopic submucosal dissection, and transanal endoscopic microsurgery, may represent safe and effective treatment options for selected patients with high-risk adenomatous polyps. When complete excision is achieved and favorable pathological features are present, particularly negative resection margins, absence of lymphovascular invasion, and well or moderately differentiated histology, surveillance without radical surgery may be an appropriate management strategy. Conversely, positive margins, piecemeal resection, rectal location, invasive adenocarcinoma, poor differentiation, and lymphovascular invasion should alert clinicians to the increased likelihood that additional radical surgery will be required.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Committee Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective multicenter study was approved by the Clinical Research Ethics Committee of Gaziosmanpaşa Training and Research Hospital (approval no: [90], date: [28.05.2020]). The study was conducted in accordance with the ethical principles of the Helsinki Declaration.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from all participants/patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest and Source of Funding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest. This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no acknowledgments to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConcept: [DG]; Design: [M\u0026Ouml;]; Data Collection and/or Processing: [DG, M\u0026Ouml;]; Analysis and/or Interpretation: [MG, RKG]; Literature Search: [M\u0026Ouml;]; Writing Manuscript: [M\u0026Ouml;, DG]; Critical Review: [M\u0026Ouml;, DG]; Final Approval: All authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021;71(3):209\u0026ndash;49.\u003c/li\u003e\n\u003cli\u003eGilbertsen VA, Knatterud GL, Lober PH, et al. Invasive carcinoma of the large intestine: A preventable disease? Surgery 1965;57:363\u0026ndash;5\u003c/li\u003e\n\u003cli\u003eVogelstein B, Fearon ER, Hamilton SR, et al. Genetic alterations during colorectal-tumor development. N Engl J Med 1988;319(9):525\u0026ndash;32.\u003c/li\u003e\n\u003cli\u003eZauber AG, Winawer SJ, O\u0026rsquo;Brien MJ, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012;366:687\u0026ndash;696. doi: 10.1056/NEJMoa1100370\u003c/li\u003e\n\u003cli\u003eNishihara R, Wu K, Lochhead P, et al. Long-term colorectal-cancer incidence and mortality after lower endoscopy. N Engl J Med 2013;369(12):1095\u0026ndash;105.)\u003c/li\u003e\n\u003cli\u003eTanaka S, Saitoh Y, Matsuda T, et al. Evidence-based clinical practice guidelines for management of colorectal polyps. J Gastroenterol. 2021;56(4):323-335. doi:10.1007/s00535-021-01776-1.\u003c/li\u003e\n\u003cli\u003eNagtegaal ID, Odze RD, Klimstra D, et al. The 2019 WHO classification of tumours of the digestive system. Histopathology 2020; 76:182-8.\u003c/li\u003e\n\u003cli\u003eAppelman HD. Con: High-grade dysplasia and villous features should not be part of the routine diagnosis of colorectal adenomas. Am J Gastroenterol. 2008; 103:1329\u0026ndash;1331.doi: 10.1111/j.1572-0241.2008.02005_3.x.\u003c/li\u003e\n\u003cli\u003eChurch JM. Avoiding surgery in patients with colorectal polyps. Dis Colon Rectum. 2003; 46:1513\u0026ndash;1516.doi: 10.1007/s10350-004-6805-9. Monika Ferlitsch, Cesare Hassan, Raf Bisschops et al. Colorectal polypectomy and endoscopic mucosal resection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline \u0026ndash; Update 2024. Endoscopy 2024; 56: 516\u0026ndash;545.\u003c/li\u003e\n\u003cli\u003eA. Ponti, A. Anttila, G. Ronco, et al. \u0026ldquo;Cancer Screening in Report on the implementation of the Council Recommendation on cancer screening,\u0026rdquo; (2017).\u003c/li\u003e\n\u003cli\u003eNagarajan, K.V. , Bhat, N. Imaging colonic polyps in 2024. \u003cem\u003eIndian J Gastroenterol\u003c/em\u003e\u003cstrong\u003e43\u003c/strong\u003e, 954\u0026ndash;965 (2024). https://doi.org/10.1007/s12664-024-01679-y.\u003c/li\u003e\n\u003cli\u003eRawla P, Sunkara T, Barsouk A. Epidemiology of colorectal cancer: incidence, mortality, survival, and risk factors. Gastroenterology Review/Przegląd Gastroenterologiczny. 2019;14(2):89-103. doi:10.5114/pg.2018.81072.\u003c/li\u003e\n\u003cli\u003eChang T-H, Chong L-W, Chang H-C, Liu Y-H, Sun C-K, Yang K-C, et al. Adenoma detection rate of screening colonoscopy among age 40\u0026ndash;75\u0026thinsp;years: Implications for lowering the age for colorectal cancer screening. \u003cem\u003eAdv Dig. Med\u003c/em\u003e. 2025; 12(1):e13410. https://doi.org/10.1002/aid2.13410\u003c/li\u003e\n\u003cli\u003eMeguid RA, Slidell MB, Wolfgang CL, Chang DC, Ahuja N. Is there a difference in survival between right- versus left-sided colon cancers? \u003cem\u003eAnn Surg Oncol\u003c/em\u003e. 2008;15(9):2388\u0026ndash;94. https://doi.org/10.1245/s10434-008-0015-y. Robert A. Meguid, Mark B. Slidell, Christopher L. Wolfgang, David C. Chang, and Nita Ahuja, Is There a Difference in Survival Between Right-Versus Left-Sided Colon Cancers? Ann Surg Oncol. 2008 September; 15(9): 2388\u0026ndash;2394. doi:10.1245/s10434-008-0015-y.\u003c/li\u003e\n\u003cli\u003eBoatman S, Mott SL, Shaukat A, et al. Endoscopic polypectomy for malignant polyps: Should tumor location (right versus left side) guide clinical decisions? \u003cem\u003eSurgery\u003c/em\u003e. 2023;173(3):674\u0026ndash;80. https://doi.org/10.1016/j.surg.2022.07.041.\u003c/li\u003e\n\u003cli\u003eMochizuki K, Kudo SE, Ichimasa K, et al. Left-sided location is a risk factor for lymph node metastasis of T1 colorectal cancer: a single-center retrospective study. \u003cem\u003eInt J Colorectal Dis\u003c/em\u003e. 2020;35(10):1911\u0026ndash;9. https://doi.org/10.1007/s00384-020-03668-x.\u003c/li\u003e\n\u003cli\u003eGupta N, Bansal A, Rao D, et al. Prevalence of advanced histological features in diminutive and small colon polyps. Gastrointest Endosc. 2012;75:1022 30. https://doi.org/10.1016/j.gie.2012.01.020.\u003c/li\u003e\n\u003cli\u003eD. Lieberman, M. Moravec, J. Holub, et al. Polyp size and advanced histology in patients undergoing colonoscopy screening: Implications for CT colonography. Gastroenterology, 135 (2008), pp. 1100-1105.\u003c/li\u003e\n\u003cli\u003eEndoscopic Classification Review Group. Update on the paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy. 2005;37:570\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eUraoka T, Saito Y, Matsuda T, et al. Endoscopic indications for endoscopic mucosal resection of laterally spreading tumours in the colorectum. Gut. 2006;55:1592\u0026ndash;1597. doi: 10.1136/gut.2005.087452.\u003c/li\u003e\n\u003cli\u003eButte J.M. Tang P. Gonen M. et. Al. Rate of residual disease after complete endoscopic resection of malignant colonic polyp. Dis Colon Rectum 2012; 55: pp. 122-127.\u003c/li\u003e\n\u003cli\u003eShaukat A, Kaltenbach T, Dominitz JA, Robertson DJ, Anderson JC, Cruise M, Burke CA, Gupta S, Lieberman D, Syngal S, Rex DK. Endoscopic Recognition and Management Strategies for Malignant Colorectal Polyps: Recommendations of the US Multi-Society Task Force on Colorectal Cancer. 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PMID: 33159840.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bratislava-medical-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Bratislava Medical Journal](https://link.springer.com/journal/44411)","snPcode":"44411","submissionUrl":"https://submission.springernature.com/new-submission/44411/3","title":"Bratislava Medical Journal","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"High-risk adenomatous polyps, Endoscopic resection, Colorectal cancer prevention, En bloc excision, Polyp morphology","lastPublishedDoi":"10.21203/rs.3.rs-9322957/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9322957/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eAdenomatous polyps with high-grade dysplasia or intramucosal carcinoma are generally managed endoscopically, while lesions with deeper invasion typically require radical resection. This study aimed to provide clinically relevant information to support colorectal cancer prevention by examining the relationships among demographic, clinical, and histopathological features and performing risk stratification of patients with detected high-risk polyps.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis retrospective multicenter study included 128 patients with high-risk adenomatous polyps treated between January 2006 and September 2025 at two tertiary referral centers. Patients were categorized according to polyp morphology as sessile, pedunculated, or mixed-morphology. Clinicopathological characteristics, treatment modalities, and follow-up data were analyzed. High-risk polyps were defined according to histopathological features associated with advanced neoplasia and potential residual disease risk.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOf the 128 patients, 55 (43.0%) had sessile, 49 (38.3%) had pedunculated, and 24 (18.8%) had mixed high-risk polyps. Age, maximum polyp size, follow-up duration, and sex distribution were comparable across the three groups, whereas rectal location, excision technique, en bloc resection, and piecemeal resection differed significantly according to polyp morphology. In multivariable analysis, positive resection margin was the only independent factor associated with radical surgery, whereas piecemeal resection, invasive adenocarcinoma histology, and rectal location were independently associated with margin positivity. No local recurrence or distant metastasis occurred during follow-up.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eHigh-risk adenomatous polyps can be safely managed without radical surgery if complete en bloc excision and low-risk pathological features are present. Under close surveillance, minimally invasive endoscopic procedures offer effective treatment for selected patients.\u003c/p\u003e","manuscriptTitle":"Can Endoscopic Resection Alone Provide Definitive Management for High-Risk Adenomatous Polyps?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-17 18:51:13","doi":"10.21203/rs.3.rs-9322957/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-04-10T11:11:42+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-08T11:25:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-08T11:24:47+00:00","index":"","fulltext":""},{"type":"submitted","content":"Bratislava Medical Journal","date":"2026-04-04T20:55:53+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bratislava-medical-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Bratislava Medical Journal](https://link.springer.com/journal/44411)","snPcode":"44411","submissionUrl":"https://submission.springernature.com/new-submission/44411/3","title":"Bratislava Medical Journal","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"bc10e9b9-926c-4ecb-97b3-89a0998bb476","owner":[],"postedDate":"April 17th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-17T18:51:13+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-17 18:51:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9322957","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9322957","identity":"rs-9322957","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}