A 55-year-old man undergoes colonoscopy and is found to have a 25 mm sessile serrated lesion in the ascending colon with no dysplasia. Endoscopic mucosal resection is attempted but incomplete with positive margins. What is the definitive management?

• A Repeat colonoscopy with endoscopic resection in 3 months
• B Right hemicolectomy with lymph node dissection
• C CT colonography surveillance in 6 months
• D Surgical segmental resection of the involved colonic segment ✓

Explanation

Sessile serrated lesions 20 mm or larger that cannot be completely removed endoscopically warrant surgical segmental resection because of the risk of interval colorectal cancer through the serrated neoplasia pathway. Right hemicolectomy with lymphadenectomy is excessive for a non-dysplastic lesion without proven malignancy. Endoscopic surveillance alone is inadequate after incomplete resection of a lesion this size.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

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