Multidisciplinary team-guided combined endoscopic laparoscopic surgery for complex colonic lesions: a single-center retrospective cohort study

PURPOSE: Combined endoscopic laparoscopic surgery (CELS) is a minimally invasive alternative treatment for complex colonic polyps that can reduce surgical overtreatment. We report implementing a standardized treatment strategy with patients selected for CELS procedures via multidisciplinary team (MDT) conferences. METHODS: This observational cohort study included 97 consecutive patients treated with CELS between 2016 and 2022. All cases were discussed by either a benign or malignant MDT. Two CELS techniques were employed: endoscopically assisted wedge resection (EA-WR) and laparoscopically assisted endoscopic mucosal resection (LA-EMR). Patients with suspected malignancies underwent step-up segmental resection (SR) if necessary. Primary outcomes were morbidity and mortality; secondary outcomes included adherence to MDT decisions, procedure durations, length of stay (LOS), histopathology, recurrence, and follow-up. RESULTS: The approach decided by the MDT was unchanged in 81% of cases (79/97). Median age was 70 years and 43% were female. Lesions had a mean size of 31 mm and were predominantly located in the right colon. Technical success for lesion removal during the index procedure was 98% (95/97), with 93% completed by CELS alone. Median operative durations were shorter for EA-WR (52 min) and LA-EMR (73 min) than for SR (163 min, p < 0.001). Median LOS was 1 day for CELS and 5 days for SR (p < 0.001). Eleven patients (11.3%) experienced complications; four required re-interventions. Adenocarcinomas were found in 15 patients (15/97, 12.6%), with treatment individualized based on intraoperative and histological findings. The recurrence rate for benign lesions was 4%; these recurrences were exclusively in the LA-EMR group. CONCLUSION: An MDT-guided strategy incorporating CELS, with optional intraoperative step-up, is an individualized and organ-preserving approach to managing complex colonic lesions that minimizes unnecessary surgical resections. This strategy has the potential to improve clinical decision-making and should be validated in multicenter settings.