Anatomical aspects of a <scp>SPECC</scp> of the colon and rectum

Fabio, Francesco Di; Moran, Brendan

doi:10.1111/codi.14489

Cited by 1 publication

(4 citation statements)

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“…There are important advantages in the approach to a rectal SPECC compared with a colonic SPECC in that endoluminal access is possible by transanal techniques and that the anatomy of the rectum, surrounded by the mesorectum, allows safer rectal SPECC resection either in the submucosal plane or even a deeper full-thickness resection. 11 We advocate the concept of the "triple assessment" approach in evaluation of rectal SPECC, which incorporates clinical rectal examination with rigid sigmoidoscopy, flexi-sigmoidoscopy, and ERUS. 12 The use of ERUS in the evaluation of presumed benign SPECC may allow selection for mucosectomy excision with about 90% accuracy, 12 minimizing unnecessary full-thickness excisions, and our results support these figures.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…The rectum was defined as the last 15 cm of the large intestine, as measured from the anal verge; when unclear, an MRI-based definition of rectum was used as the part of the lower large bowel that is surrounded in part, or completely, by the mesorectal fat and mesorectal fascial envelope. 11 All patients underwent initial colonoscopy, during which a decision was made on whether to proceed to endoscopic excision or to postpone treatment with discussion at the SPECC MDT. Routine policy was that patients with rectal SPECC lesions should have a pelvic MRI.…”

Section: Methodsmentioning

confidence: 99%

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Management of Significant Polyp and Early Colorectal Cancer Is Optimized by Implementation of a Dedicated Multidisciplinary Team Meeting: Lessons Learned From the United Kingdom National Program

Fabio

Jitsumura

Longstaff

et al. 2022

Diseases of the Colon &Amp; Rectum

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BACKGROUND:The concept of significant polyps and early colorectal cancer encompasses complex polyps not amenable to routine snare polypectomy or where malignancy cannot be excluded. The assessment and management of these lesions is contentious and increasingly important due to the significant risk of over-or undertreatment. OBJECTIVE:Following the recommendations of the Significant Polyps and Early Colorectal Cancer National Program, we implemented a dedicated multidisciplinary team meeting and analyzed the influence on patient outcomes. DESIGN:This was a retrospective study using a prospectively collected database of patients discussed at the dedicated multidisciplinary team meeting. SETTINGS:This study was conducted in a single tertiarycare center.PATIENTS: Consecutive patients with significant polyps and early colorectal cancer were identified either through the Bowel Cancer Screening Program or colonoscopy for symptomatic patients. MAIN OUTCOME MEASURES:Proportions of patients who had organ preservation, and secondary treatment and recurrence rate served as outcome measures. RESULTS:Overall, 135 patients discussed at the dedicated multidisciplinary team meeting were included, with a median age of 71 years. Median size of the lesions was 25 mm, and 39% were in the rectum. Patients were discussed either after the lesion was removed during the initial colonoscopy (n = 38), of whom 16 (42%) had unexpected cancer, or had no initial treatment with subsequent case review (n = 97). Of these 97 patients, 46 underwent endoscopic excision (26% cancer), 20 transanal excision (10% cancer), 23 primary surgical resection (35% cancer), and 8 had no treatment. In 104 (82%) patients, organ preservation was achieved. Secondary surgery was required in 7 of 104 (6.7%) patients after local excision due to radical treatment of high-risk T1 lesions, local recurrence, or patients' decisions. The cumulative hazard estimates for recurrence after a median follow-up of 18.5 months was less than 10% for both benign and malignant lesions. LIMITATIONS:This study was limited by its relatively small sample size and single-center setting. CONCLUSIONS:A dedicated multidisciplinary team meeting improved the management of significant polyps and early colorectal cancer, safely refining organ preservation for patients, with low recurrence rates. See

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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