Bronchogenic Cyst: Lessons Learned in 20 Years of Experience at a Tertiary Pediatric Center.

BACKGROUND: Bronchogenic cysts are benign congenital malformations of the primitive ventral foregut. The aim of this study is to analyze and report 20 years of experience in the diagnosis and treatment of bronchogenic cysts at a tertiary pediatric center. METHODS: A retrospective review was conducted of all patients diagnosed with a bronchogenic cyst between 2000-2020. Presence of symptoms, cyst location, surgical technique, postoperative complications, need for pleural drainage, and recurrence were reviewed. RESULTS: Forty-five children were included in the study. In 37 patients a partial resection of the cyst was done, followed by cauterization or chemical obliterateration with iodopovidone of the mucosa of the remaining cyst wall that was adherent to the airway. A lobectomy was done in patients who had intrapulmonary cysts (n = 8). Cyst location was subcarinal in 23 (51.1%), paratracheal in 14 (31.1%), and intrapulmonary in eight patients (17.8%). The majority of subcarinal and paratracheal cysts (90%) were approached by thoracoscopy. Complications occurred in seven patients (15%): subcutaneous emphysema after pleural drain removal in one, extubation failure in two, reoperation due to bleeding in one, surgical site infection in one, bronchopleural fistula in one, and pneumothorax in one. Reoperation due to cyst recurrence was necessary in two patients (4.4%). Mean follow-up was 56 months (range, 0-115). CONCLUSION: A minimally invasive approach is a safe option for the management of paratracheal and subcarinal bronchogenic cysts with no history of infection in specialized pediatric surgery center. Thoracoscopic partial resection is a feasible option in most patients with subcarinal and paratracheal bronchogenic cysts with a low complication and reoperation rate. LEVEL OF EVIDENCE: IV.

Risk-stratified Results among Congenital Diaphragmatic Hernia Patients in Two Large Extracorporeal Membrane Oxygenation Centers in South America.

INTRODUCTION: Mortality related to CDH is high, but with great variability among centers. There are few studies on patients with this condition born in South America which show poor outcomes. The goal of this study is to present the outcome of CDH in several high-volume quaternary centers in South America, ascertain the factors associated with lower mortality in our population, and compare our outcomes to those of the CDH Study Group (CDHSG). METHODS: The data from two South American centers were retrospectively analyzed and compared with contemporary data from other CDHSG participating centers. Patient demographic and clinical characteristics were also evaluated and compared. RESULTS: Between 2013 and 2018, the two South American centers saw 335 patients with CDH with an overall survival rate of 73.1%. Survival for the high, intermediate, and low-risk groups as determined by the Brindle score was 50%, 70%, and 87%, respectively. In our cohort the strongest predictors of mortality were ECMO use and early PaCO2. There were no significant differences in mortality between the two South American centers and the other CDHSG centers when adjusted by risk score, however, the South American centers had higher use of ECMO in the intermediate-risk group. DISCUSSION: Quaternary South American centers had similar outcomes to CDHSG centers worldwide. The availability and coordination of centralized dedicated care allow more efficient use of scarce technical and professional resources in patients with CDH. LEVEL OF EVIDENCE: III.

Surgical treatment of thoracic outlet syndrome in pediatrics.

AIM: Thoracic outlet syndrome (TOS) is a condition that occurs when the cervical neuro-vascular bundle becomes compressed at one of the three narrow areas of the thoraco-cervico-axillary region. Conservative management is the first line of treatment. Patients who do not respond to conservative management should be treated surgically. The aim of this review is to present our experience with the surgical management of TOS in pediatric patients. METHODS: We retrospectively reviewed the outcomes of all patients with TOS operated at our Hospital between 2001 and 2020. We collected all demographic data, clinical features, imaging data, type of operation performed, intraoperative findings, complications and recurrence. RESULTS: We operated 9 patients within the study period. The median age at surgery was 14 (7 to 17) years. A transaxillary approach was used in 7 patients and a supraclavicular approach in 2. There was only one minor intraoperative complication (violation of the pleural space). There were no postoperative complications. The median length of stay was 3 (2 to 4) days. All patients were extubated in the operating room. Two patients developed symptoms on the contralateral side. One of these underwent a successful contralateral transaxillary Roos operation. The follow-up was 4 months to 20 years. All patients are asymptomatic. CONCLUSION: We believe that the Roos operation is a safe and effective treatment with excellent long-term outcomes for children with TOS that fail conservative management.

Nefroma mesoblastico congénito: reporte de un caso / Congenital mesoblastic nephroma: case report

El nefroma mesoblastico congénito es un tumor renal infrecuente, pero común en el periodo neonatal. De comportamiento benigno y pronóstico excelente en su variedad clásica pero en el subtipo celular puede presentar recurrencia local, invasión retroperitoneal y metástasis pulmonares y cerebrales. El tratamiento es la nefrectomía radical. Los factores pronósticos son la edad menor a tres meses y la resección quirúrgica completa. Paciente de 17 días nacida a las 35 semanas por polihidramnios, con diagnóstico prenatal de masa abdominal. Al examen físico masa en flanco derecho e hipertensión arterial (121/79 mm Hg, TAM 77mm Hg). Ecografía abdominal con riñón derecho aumentado de tamaño y voluminosa formación sólida, de 4,4 x 4,3 x 4,8 cm, heterogénea y vascularizada al Doppler en polo inferior. Tomografía de abdomen con formación nodular heterogénea de 5,0 x 4,1 x 5,1 cm en polo inferior del riñón derecho. Se realizó nefrectomía radical derecha sin complicaciones. Evolución en los últimos 20 meses satisfactoria y libre de enfermedad.

Congenital mesoblastic nephroma is an uncommon renal tumor, but frequent in neonates. Classical variety usually benign with excellent prognosis. Cellular cases may be recurrent with retroperitoneal invasion, brain and lung metastasis. Radical nephrectomy is the treatment of choice. Relevant prognostic factors are diagnosis before three months of age and complete resection. A 17 day old patient, borned at 35 weeks due to polyhydramnios, with prenatal diagnosis of abdominal mass. On examination, right flank abdominal mass and arterial hypertension (121/79 mm Hg, MAP 77 mm Hg). Abdominal ultrasound showed an enlarged right kidney with a voluminous solid heterogeneous mass, 4.4 x 4.3 x 4.8 cm in the lower pole, vascularized on Doppler scan. Computed tomography showed a big 5.0 x 4.1 x 5.1 cm, nodular, heterogeneous mass in the lower pole of the right kidney. Right radical nephrectomy was performed with an uneventful recovery. Follow up for the last 20 months satisfactory and free of disease.

Biological versus synthetic patch for the repair of congenital diaphragmatic hernia: 8-year experience at a tertiary center.

PURPOSE: The aim of this study is to compare outcome between small intestinal submucosal (SIS) and polytetrafluoroethylene (PTFE) patches in patients with congenital diaphragmatic hernia (CDH) with large muscular defects. MATERIAL AND METHODS: We performed a retrospective review of prospectively collected data of patients who underwent CDH repair from January 2011 to June 2019, with a minimum follow-up of 1 year. Data were collected regarding length of stay (LOS), mortality and recurrence. Kaplan-Meier analyses was used. RESULTS: In the study period, 195 patients with CDH were admitted, 176 underwent surgical repair and 19 died before surgery. Sixty-two (35%) required a patch. Over the last 5 years, our institution transitioned from the use of all SIS to all PTFE. SIS was used in 18 cases and PTFE in 25. Overall survival rate was 89% (174/195). There was no significant difference regarding LOS and mortality. Nine patients (50%) of SIS and 1 (4%) of PTFE repairs recurred (P < 0.01; log-rank test P <  0.01), with a time course of recurrence of 18 (SD = 13) and 8 months, respectively. Median follow-up was 60 months (SD: 23) for the SIS group and 26 (SD: 10) for the PTFE group. CONCLUSION: A significant lower recurrence was found using PTFE patches instead of SIS for the repair of large CDH. LEVEL OF EVIDENCE: Level 3. Retrospective comparative study.

Giant omphalocele: Delayed closure using the San Martin technique following epithelialization of the membrane.

AIM: The management of patients with congenital anterior abdominal wall defects remains challenging, particularly in cases of giant omphalocele. In 1948, San Martín described a surgical technique for the repair of large midline incisional hernias in adults without the need for a mesh. The purpose of this report is to describe our experience with this technique for the delayed closure of giant omphaloceles. METHODS: We retrospectively reviewed the outcomes of all patients with giant omphalocele managed with the San Martin technique between September 2013 and March 2019. Data collected included birth weight, gestational age, associated malformations, neonatal hospital stay, age at the time of the abdominal wall closure, days on mechanical ventilation (MV) after the closure, time to initiation of enteral feedings, intra- and postoperative complications, and postoperative hospital stay. RESULTS: A total of 8 patients were included in the study. The median birth weight was 3.190 (2.150 to 3.400) grams. The median gestational age was 35 (32 to 38) weeks. The median age at surgery was 6 (5 to 13) years. The median postoperative days on MV was 3 (3 to 11) days. Enteral feeding were initiated postoperatively at a median of 4 (2 to 4) days. There was one intraoperative complication (minor vascular injury). There were no short-term or long-term complications directly related to the surgical technique. The median postoperative hospital stay was 10 (6 to 16) days. The follow-up was 18 months to 8 years. CONCLUSION: We believe that the San Martín technique is a valid alternative for the delayed closure of giant omphaloceles. LEVEL OF EVIDENCE: According to the Journal of Pediatric Surgery this research corresponds to type of study level IV for case series with no comparison group.

Lung destruction secondary to intrapulmonary migration of a ventriculoperitoneal shunt catheter: report of an unusual case and literature review.

Ventriculoperitoneal shunt placement for the treatment of hydrocephalus is one of the most common pediatric neurosurgical procedures. Complications, including infections, catheter obstruction, shunt breakdown, and hemorrhage, have been described in the literature. Occasionally, however, uncommon and devastating complications occur. We report a case of a 10-year-old female patient who at birth underwent surgical closure of lumbar myelomeningocele and placement of a CSF shunt at another center. Her neurosurgical follow-up was poor. She presented at our institution with a history of recurrent pneumonia. Control chest X-rays showed a right pulmonary infiltrate with lung retraction and mediastinal shift. Chest and brain CT scans confirmed the intrapulmonary location of the distal catheter tip and ventricular dilation. Surgical shunt revision was performed with removal of the intrapulmonary catheter and placement of a new intraperitoneal catheter. Subsequently, right pneumonectomy was performed with good postoperative recovery of the patient. Intrathoracic migration of the distal catheter of the CSF shunt is an extremely rare complication that may produce severe morbidity. To our knowledge, there have been no previous reports on extensive lung destruction secondary to intrathoracic and intrapulmonary ventriculoperitoneal shunt migration. In patients with CSF shunts and pulmonary symptoms, intrapulmonary catheter migration should be considered.

Risk factors for morbidities and mortality in children following pneumonectomy.

BACKGROUND AND OBJECTIVE: Pneumonectomy (PNE) is a procedure infrequently performed in children. A high morbidity/mortality rate associated with PNE has been described. Few series have been published in the last 15 years. Risk factors associated with morbidity/mortality after PNE were evaluated. Indications, course, survival and complications of PNE in children were also analized. METHODS: In a case series of 51 children who underwent PNE, death within 30 days of surgery, pneumonia, empyema, sepsis, adult respiratory distress syndrome, bronchopleural fistula, bleeding, pneumothorax and post-PNE syndrome were considered major morbidities. Scoliosis, wound infection and atelectasis were considered minor morbidities. RESULTS: Median age at PNE was 7.4 years; 45% were males. Indications of pneumonectomy were postinfectious bronchiectasis (61%), tumours (17%), pulmonary malformations (17%), aspiration syndrome (14%), cystic fibrosis (6%), immunodeficiency (4%) and trauma (2%). Mortality rate was 4% at 1 month. Major and minor morbidities were present in 23% and 27% of patients, respectively. Risk factors for development of morbidities after PNE were age ≤ 3 years (OR: 16.7; 95% CI: 2.4-117) and the need for mechanical ventilation for at least 4 days (OR: 8; 95% CI: 1.5-43.6). CONCLUSION: Children are at high risk of death, major and minor morbidities following PNE. Caution is recommended for this group of patients.

Fístula broncobiliar congénita: Caso dínico / Congenital broncho-biliary fistula: A case report

La fístula traqueo- o broncobiliar congénita o fístula hepatopulmonar congénita es una rara malformación con alta morbimortalidad si su diagnóstico no se realiza a tiempo. Existe una comunicación entre el sistema respiratorio (tráquea o bronquio) y el tracto biliar. Hasta la fecha, se han reportado solo 35 casos. Presentamos el caso de un neonato con neumopatía derecha y débito bilioso por el tubo endotraqueal. El diagnóstico se realizó mediante broncoscopía con radioscopía y la resección de la fístula broncobiliar fue por videotorascopía. Posteriormente, se requirió de una hepatectomía izquierda con anastomosis biliodigestiva en Y de Roux por presentar hipoplasia de colédoco.

Congenital tracheo-or-bronchobiliary fistula or congenital he-patopulmonary fistula is a rare malformation with high morbidity and mortality if the diagnosis is not made early. The tracheo-or-bronchobiliary fistula is a communication between the respiratory (trachea or bronchus) and biliary tract. To date, only 35 cases have been published worldwide. We report a case of a neonate with right pneumonia and bilious fluid in the endotracheal tube. Diagnosis was made using bronchoscopy with fluoroscopy. Videothoracoscopy was used to remove the bronchobiliary fistula. Subsequently, a left he-patectomy with Roux-en-Y biliary-digestive anastomosis was performed as bile ductus hypoplasia was present.

[Congenital broncho-biliary fistula: a case report]. / Fístula broncobiliar congénita: caso dínico.

Congenital tracheo-or-bronchobiliary fistula or congenital he-patopulmonary fistula is a rare malformation with high morbidity and mortality if the diagnosis is not made early. The tracheo-or-bronchobiliary fistula is a communication between the respiratory (trachea or bronchus) and biliary tract. To date, only 35 cases have been published worldwide. We report a case of a neonate with right pneumonia and bilious fluid in the endotracheal tube. Diagnosis was made using bronchoscopy with fluoroscopy. Videothoracoscopy was used to remove the bronchobiliary fistula. Subsequently, a left he-patectomy with Roux-en-Y biliary-digestive anastomosis was performed as bile ductus hypoplasia was present.

La fístula traqueo- o broncobiliar congénita o fístula hepatopulmonar congénita es una rara malformación con alta morbimortalidad si su diagnóstico no se realiza a tiempo. Existe una comunicación entre el sistema respiratorio (tráquea o bronquio) y el tracto biliar. Hasta la fecha, se han reportado solo 35 casos. Presentamos el caso de un neonato con neumopatía derecha y débito bilioso por el tubo endotraqueal. El diagnóstico se realizó mediante broncoscopía con radioscopía y la resección de la fístula broncobiliar fue por videotorascopía. Posteriormente, se requirió de una hepatectomía izquierda con anastomosis biliodigestiva en Y de Roux por presentar hipoplasia de colédoco.

Primary lung tumors in children: 24 years of experience at a referral center.

PURPOSE: Primary lung tumors are rare during childhood and encompass a wide variety of histological types. Each has a different biology and a different therapeutic approach. The aim of this article is to review the experience of a pediatric referral center with this kind of tumors during the last 24 years. METHODS: A retrospective chart review was performed for patients with diagnosis of primary lung tumor between the years 1990-2014. The variables analyzed were age, sex, course of the disease, symptoms, localization, surgery, histology and outcome. RESULTS: Between 1990 and 2014, 38 patients with primary lung tumors were treated at our institution. Age at presentation was 6.6 ± 5.2 years (r 0.91-16.58) and the female:male relationship was 1.37. Inflammatory myofibroblastic lung tumor (n = 13), carcinoid tumor (n = 6) and pleuropulmonary blastoma (n = 6) were the most frequent histological types. Persistent radiographic abnormality was the most frequent presenting sign (34 %). Global mortality was 15.8 % varying according to histology. CONCLUSION: Although the diagnosis of primary lung tumor is rare, the persistence of a radiographic abnormality in spite of adequate treatment for inflammatory processes forces us to evaluate further. The age of the patient is an important factor in the decision of the diagnostic work-up.

[Late diagnosis bilateral congenital diaphragmatic hernia: a case report]. / Hernia diafragmática congénita bilateral de diagnóstico tardío: reporte de un caso.

Congenital diaphragmatic hernia (CDH) is a rare malformation, usually unilateral and left sided. Bilateral CDH (B-CDH) represents 1% of all CDH. Mortality is higher in right side and bilateral defects. We report a case of a patient with Bilateral CDH, initially diagnosed and treated as unilateral right CDH. At 8 months during a laparoscopic Ladd procedure a left side CDH was found.

La hernia diafragmática congénita (HDC) es una malformación rara, habitualmente unilateral y más frecuente del lado izquierdo. La HDC bilateral representa el 1% de todas las HDC. La mortalidad es mayor en las HDC derechas y en las bilaterales. Reportamos el caso de un paciente con HDC bilateral, cuya malformación inicialmente se diagnosticó y trató como una HDC derecha. Luego se encontró la presencia de HDC izquierda durante la cirugía de Ladd laparoscópica a los 8 meses de edad.

Hernia diafragmática congénita bilateral de diagnóstico tardío: reporte de un caso / Late diagnosis bilateral congenital diaphragmatic hernia: a case report

La hernia diafragmática congénita (HDC) es una malformación rara, habitualmente unilateral y más frecuente del lado izquierdo. La HDC bilateral representa el 1% de todas las HDC. La mortalidad es mayor en las HDC derechas y en las bilaterales. Reportamos el caso de un paciente con HDC bilateral, cuya malformación inicialmente se diagnosticó y trató como una HDC derecha. Luego se encontró la presencia de HDC izquierda durante la cirugía de Ladd laparoscópica a los 8 meses de edad.

Congenital diaphragmatic hernia (CDH) is a rare malformation, usually unilateral and left sided. Bilateral CDH (B-CDH) represents 1% of all CDH. Mortality is higher in right side and bilateral defects. We report a case of a patient with Bilateral CDH, initially diagnosed and treated as unilateral right CDH. At 8 months during a laparoscopic Ladd procedure a left side CDH was found.

Umbilical arteriovenous malformation in a healthy neonate with umbilical hernia.

We describe the case of a neonate with an umbilical hernia and persistent wet umbilicus. Examination revealed a pulsatile umbilical cord with palpable thrill. Doppler ultrasound suspected umbilical arteriovenous malformation and contrast-enhanced computed tomography was performed leading to a definitive diagnosis. Surgery was successfully performed on day 27.

[Surgical treatment of tracheal stenosis in pediatrics]. / Tratamiento quirúrgico de la estenosis traqueal en pediatría.

Twenty patients with tracheal stenosis were surgically treated between July 2005 and May 2008; ten patients had a congenital stenosis and ten an acquired one. Global survival was 85%. Three patients died: 1 with acquired stenosis and 2 with congenital stenosis. From 17 alive patients, 15 remain asymptomatic; 2 patients operated on due to congenital stenosis, are under continuous follow-up (both with stents placed in the trachea). Surgical treatment of acquired stenosis presents less severe complications, requires less ventilatory support and hospital stay. Conversely, congenital stenosis often requires more than one procedure to control the disease, and presents a higher mortality rate.

Tratamiento quirúrgico de la estenosis traqueal en pediatría / Surgical treatment of tracheal stenosis in pediatrics

Veinte pacientes con estenosis de tráquea fueron intervenidos quirúrgicamente entre julio de 2005y mayo de 2008, diez con estenosis congénita y diez de origen adquirido.La sobrevida global fue de 85 por ciento. Fallecieron tres pacientes, uno con estenosis adquirida y dos conestenosis congénita.De los diecisiete sobrevivientes, quince se encuentran asintomáticos; dos pacientes operados por estenosis congénita requieren controlesperiódicos (ambos con tutores endoluminales [stents] colocados).La estenosis traqueal adquirida presenta menos complicaciones, requiere menos asistencia respiratoria y menor estadía hospitalaria en el posoperatorio. Los pacientes con estenosis traquealcongénita necesitan, generalmente, másde un procedimiento terapéutico y presentan mayor mortalidad.(AU)

Tratamiento quirúrgico de la estenosis traqueal en pediatría / Surgical treatment of tracheal stenosis in pediatrics

Veinte pacientes con estenosis de tráquea fueron intervenidos quirúrgicamente entre julio de 2005y mayo de 2008, diez con estenosis congénita y diez de origen adquirido.La sobrevida global fue de 85 por ciento. Fallecieron tres pacientes, uno con estenosis adquirida y dos conestenosis congénita.De los diecisiete sobrevivientes, quince se encuentran asintomáticos; dos pacientes operados por estenosis congénita requieren controlesperiódicos (ambos con tutores endoluminales [stents] colocados).La estenosis traqueal adquirida presenta menos complicaciones, requiere menos asistencia respiratoria y menor estadía hospitalaria en el posoperatorio. Los pacientes con estenosis traquealcongénita necesitan, generalmente, másde un procedimiento terapéutico y presentan mayor mortalidad.

Tailgut cyst (Retrorectal hamartoma): report of a pediatric case.

Tailgut cyst (TGC) is an uncommon congenital lesion, located in the retrorectal/presacral space. We report a 12-year-old girl with lumbar pain and a retrorectal mass. She had mental retardation, hypothyroidism, didelphus uterus, sacrum vertebrae, and coccyx agenesis, without chromosomic anomalies. Three surgeries were performed for the complete excision of the tumor. Microscopically, the mass consisted of cystic spaces lined by a wide variety of epithelia and a stroma composed of fibrous tissue containing bundles of smooth muscle fibers. According to these findings, the diagnosis was TGC. This is a rare congenital lesion that usually presents as a multiloculated cyst in the retrorectal space of young women; TGC requires complete surgical excision to prevent recurrences, infections, and malignant transformation. This case was unique because of the association of TGC with other malformative features and concomitant disease in a pediatric patient.

Polipectomía Endoscópica y manejo de los pólipos colorrectales malignos: experiencia de 20 años / Endoscopic polypectomy and management of malignant colorrectal polyps: Twenty-year experience

Introducción: La mayoría de los autores consideran que la polipectomía es el tratamiento adecuado para los pólipos con adenocarcinoma invasor y reservan la colectomía para casos seleccionados de acuerdo a diversos factores de riesgo. Objetivo: Evaluar nuestra eficacia en el manejo de los pólipos malignos, e identificar los posibles factores clínicos y patológicos relacionados con un pronóstico desfavorable luego de la polipectomía endoscópica. Pacientes y métodos: Se revisaron retrospectivamente las historias clínicas y se incluyeron los pacientes con pólipos nalignos extirpados endoscópicamente, entre marzo de 1981 y marzo de 2001. Los pólipos fueron clasificados como de bajo o alto riesgo. Los de alto riesgo debían tener uno o más de los siguientes factores: margen comprometido, grado III de diferenciación, nivel 4 de Haggitt, o invasión de los vasos linfáticos o venosos. Se definió como resultado adverso luego de la polipectomía, la presencia de cáncer residual y/o metástasis ganglionares en la pieza de colectomía, o la recurrencia local y/o distancia encontrada en el seguimiento. Se comparó la supervivencia a 5 años libre de recurrencia entre los pacientes tratados sólo con polipectomía y los colectomizados. Resultados: se incluyeron 24 pacientes. En 3 no pudo obtenerse ningún dato de la evolución. En los restantes el seguimiento osciló entre 2 y 191 meses (mediana: 56; media: 86,7 ñ 72,3 meses). El 12,5 por ciento de los pólipos fueron Grado III. Cuatro presentaban invasión linfovascular. El margen estaba comprometido en 7 (29 por ciento) casos. El nivel de invasión fue 4 en un sólo caso. Hubo 14 (58 por ciento) pólipos de bajo riesgo y 10 (42 por ciento) de alto riesgo. Sólo hubo 2 (8 por ciento) pacientes con resultado adverso y ambos tenían pólipos de alto riesgo, con más de una característica histológica desfavorable. A pesar de esto, la diferencia con los pólipos de bajo riesgo con respecto a la evolución no alcanzó significación estadística (p=0,16). Tampoco se halló diferencia entre un resultado adverso y la presencia de distintos factores de riesgo aislados. La supervivencia a 5 años libre de recurrencia no fue diferente entre los pacientes tratados por polipectomía sola (80,2 por ciento) y los que tuvieron polipectomía seguida de colectomía (83,3 por ciento) (p=0,74). Conclusión: El tratamiento de los pólipos de bajo riesgo por polipectomía endoscópica es seguro...(AU)

Polipectomía Endoscópica y manejo de los pólipos colorrectales malignos: experiencia de 20 años / Endoscopic polypectomy and management of malignant colorrectal polyps: Twenty-year experience

Introducción: La mayoría de los autores consideran que la polipectomía es el tratamiento adecuado para los pólipos con adenocarcinoma invasor y reservan la colectomía para casos seleccionados de acuerdo a diversos factores de riesgo. Objetivo: Evaluar nuestra eficacia en el manejo de los pólipos malignos, e identificar los posibles factores clínicos y patológicos relacionados con un pronóstico desfavorable luego de la polipectomía endoscópica. Pacientes y métodos: Se revisaron retrospectivamente las historias clínicas y se incluyeron los pacientes con pólipos nalignos extirpados endoscópicamente, entre marzo de 1981 y marzo de 2001. Los pólipos fueron clasificados como de bajo o alto riesgo. Los de alto riesgo debían tener uno o más de los siguientes factores: margen comprometido, grado III de diferenciación, nivel 4 de Haggitt, o invasión de los vasos linfáticos o venosos. Se definió como resultado adverso luego de la polipectomía, la presencia de cáncer residual y/o metástasis ganglionares en la pieza de colectomía, o la recurrencia local y/o distancia encontrada en el seguimiento. Se comparó la supervivencia a 5 años libre de recurrencia entre los pacientes tratados sólo con polipectomía y los colectomizados. Resultados: se incluyeron 24 pacientes. En 3 no pudo obtenerse ningún dato de la evolución. En los restantes el seguimiento osciló entre 2 y 191 meses (mediana: 56; media: 86,7 ñ 72,3 meses). El 12,5 por ciento de los pólipos fueron Grado III. Cuatro presentaban invasión linfovascular. El margen estaba comprometido en 7 (29 por ciento) casos. El nivel de invasión fue 4 en un sólo caso. Hubo 14 (58 por ciento) pólipos de bajo riesgo y 10 (42 por ciento) de alto riesgo. Sólo hubo 2 (8 por ciento) pacientes con resultado adverso y ambos tenían pólipos de alto riesgo, con más de una característica histológica desfavorable. A pesar de esto, la diferencia con los pólipos de bajo riesgo con respecto a la evolución no alcanzó significación estadística (p=0,16). Tampoco se halló diferencia entre un resultado adverso y la presencia de distintos factores de riesgo aislados. La supervivencia a 5 años libre de recurrencia no fue diferente entre los pacientes tratados por polipectomía sola (80,2 por ciento) y los que tuvieron polipectomía seguida de colectomía (83,3 por ciento) (p=0,74). Conclusión: El tratamiento de los pólipos de bajo riesgo por polipectomía endoscópica es seguro...