Cure Called 100% if No Malignancy Is Found in Polyp

The type of colon surgery to be performed today on President Reagan to remove what White House spokesmen describe as a “large precancerous glandular polyp” should lead to excellent results if no malignancy is detected during the three-hour operation, surgery experts said Friday.

“If the polyp turns out to not be malignant, the cure should be 100%,” said Dr. Albert Yellin, professor of surgery at the USC School of Medicine. “Even if a small amount of cancer is detected, the success rate should be close to 100%.”

When asked if Reagan’s age of 74 years may make the outcome more questionable, the surgeon replied: “If he’s healthy enough to be President, he’s healthy enough to do this with no concern.”

The operation, which generally requires the removal of 12 to 15 inches of the large bowel, should not result in the need for a colostomy--the surgical creation of a new opening on the surface of the skin for elimination, Yellin said.

The polyp is in the cecum, that part of the large bowel where the appendix is situated and where the small intestine joins the large intestine. The White House gave no indication of its size except to describe it as large.

Smaller Polyp Removed

The polyp was discovered Friday during an examination of Reagan’s intestinal tract at the Bethesda Naval Hospital, where he went to have a smaller “pseudo polyp” removed.

The newly discovered growth, described as a “villus adenomatous”-appearing glandular polyp, is the less common of two varieties of polyps that cause doctors to be concerned about the possibility of malignancy.

After the polyp was discovered, doctors said they believed it was precancerous. But, according to Yellin, one of the concerns over villus-type polyps is that parts of the growth not biopsied may later be found to be malignant.

By precancerous, doctors mean that abnormalities in the structure of cells usually give a sign that there is a chance of progression to full-blown cancer.

Although it is often possible to remove polyps in the cecum area by means of an instrument called a colonoscope--without the necessity of opening the abdomen--the physicians apparently decided that the polyp was too large or too flat to be removed except by surgery.

Villus polyps sometimes grow on a stalk, which makes them easier to snip off with the colonoscope. But, if there is no stalk, or if the surgeons decide that the growth is too large to be removed safely with the instrument, they turn to full surgery.

Villus polyps range in size from less than one-quarter of an inch to more than four inches. The term villus means frond-like, referring to its leaf-like appearance.

Yellin said that the typical healthy patient who has undergone this operation is out of bed the next day.

Painkiller Needed

“For the first two to three days there may be a need for a narcotic-type painkiller,” the surgeon said. “For that reason, I would assume that important decisions would not be made. But, by about the third day, most patients are able to walk and not need painkillers. They should then be able to make lucid decisions.”

Yellin said that, if there continues to be no hint of malignancy, the likelihood of recurrence of any serious problem at the site of the polyp is virtually zero.

If some cancer is found within the polyp, the likelihood of a recurrence would depend on how deeply the tumor cells had invaded the tissues, he said.