Appendiceal Polyps: When Surgery is Necessary - Gastroenterology and Hepatology

Appendiceal polyp

Hello, Doctor.
I recently underwent a routine colonoscopy, and a tubular adenoma measuring 0.8 to 1.0 cm was found at the cecal-appendiceal junction.
Due to its location, it could not be removed directly with the endoscope.
During my follow-up appointment today, the doctor recommended surgery, stating that the sooner, the better.
The plan is to remove nearly 30 cm of the colon.
I was quite shocked, as I initially thought only the appendix would need to be removed.
I would like to ask for your opinion on whether this can be monitored instead, for example, with a colonoscopy every six months, and if there are no significant abnormalities, whether removal is necessary.
My mother also has a similar polyp in the same location, and she did not undergo surgery due to her age (90 years old).
Could it be possible for me to leave it alone without issues as well? In recent years, my physical condition has noticeably declined, and I am really scared about having 30 cm of my colon removed for a polyp that is less than 1 cm.
I am also concerned about the risks of surgery and health issues afterward.
I would appreciate your advice.
Thank you!
Response: Taoyuan Hospital / Gastroenterology / Dr.
Chi-Feng Chen, 2017/08/03.
Please discuss your concerns in detail with your physician, as it is difficult to determine the need for surgery based on the information provided.
Why is surgery necessary?
Hello, Doctor.
This is a follow-up to my previous question.
The doctor explained that the polyp is located at the junction of the cecum and appendix, making it impossible to remove via endoscopy, thus requiring surgical intervention.
The doctor indicated that to rule out the possibility of malignancy at the polyp's base, the entire procedure should be treated as if it were for malignant tumor removal, necessitating the excision of 30 cm (approximately one-third of the colon).
A biopsy of the polyp showed it to be benign, but the doctor mentioned that while the surface appears benign, there is still a possibility of malignancy at the root that cannot be seen.
Since surgery is required, it is better to remove it all at once to eliminate the risk of it becoming malignant.
However, I still feel that removing 30 cm of my colon for a benign polyp measuring less than 1 cm is quite alarming.
My physical condition is not good, and I fear that the surgery may worsen my health.
I would like to ask for your opinion.
Thank you!

Li Tai Tai, 60~69 year old female. Ask Date: 2017/08/04

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Surgery on the colon typically involves either resection of the right half or the left half of the colon; if considered as tumor surgery, it is necessary to remove half of the colon.

Reply Date: 2017/08/04

More Info

When it comes to appendiceal polyps, particularly those found at the junction of the appendix and cecum, the decision to proceed with surgery can be complex and often depends on several factors, including the size and characteristics of the polyp, the patient's overall health, and the potential risks associated with both surgery and observation.

In your case, the discovery of a tubular adenoma measuring 0.8 to 1.0 cm at the appendiceal orifice raises some important considerations. While the polyp has been identified as benign based on histological examination, the location of the polyp poses a challenge for endoscopic removal. This is significant because polyps located at the junction of the appendix and cecum can be more difficult to manage endoscopically, and there is a concern that incomplete removal could lead to the development of malignancy over time.

Your physician's recommendation to remove a significant portion of the colon (approximately 30 cm) is likely based on a precautionary principle. The rationale here is to ensure that any potentially malignant tissue is removed entirely, thereby reducing the risk of cancer development in the future. This approach is often taken when there is uncertainty regarding the complete removal of the polyp, especially when it is located in a challenging area.

However, your concerns about the extent of the surgery and the potential impact on your health are valid. Surgical procedures, especially those involving significant resections of the bowel, carry risks such as infection, bleeding, and complications related to anesthesia. Additionally, the recovery process can be challenging, particularly if you are already experiencing a decline in physical health.

In terms of observation, it is essential to have a thorough discussion with your healthcare provider about the risks and benefits of both surgery and continued surveillance. While some patients may opt for a watchful waiting approach, this is typically more feasible when there is a clear understanding of the risks involved and when the polyp can be monitored effectively. Regular colonoscopies may be an option, but they would need to be performed frequently enough to catch any changes early.

Given your family history of similar polyps, it is also worth considering genetic factors that may influence your risk of developing colorectal cancer. If your mother has had similar issues without surgical intervention, it may provide some context for your situation, but it is crucial to remember that each case is unique.

Ultimately, the decision should be made collaboratively with your healthcare team, taking into account your specific medical history, the characteristics of the polyp, and your personal preferences. If you feel uncertain or uncomfortable with the proposed surgical plan, seeking a second opinion from another gastroenterologist or colorectal surgeon could provide additional insights and help you make a more informed decision.

In summary, while surgery may be recommended to prevent potential malignancy, it is essential to weigh the risks and benefits carefully. Open communication with your healthcare provider is key to ensuring that you feel confident and informed about your treatment options.

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