Extent of unnecessary surgery for benign rectal polyps in the Netherlands

Abstract

Over the last 10 years the rate of radical rectal surgery for a benign polyp declined. However, a significant subgroup of patients was still referred for invasive surgery at the cost of high morbidity and mortality. Referral to an expert endoscopist may avoid unnecessary surgery in most cases.

Suboptimal endoscopic cancer recognition in colorectal lesions in a national bowel screening programme

“…However, the positive predictive value in this study was quite low at 69% (95% CI 57 to 78), which resulted in unnecessary surgery. This was also shown in other studies 19 20. Hence, we can conclude that incorrect optical diagnosis for predicting SM and SMd invasion results in suboptimal use of endoscopic and surgical treatment options, resulting in both overtreatment and undertreatment.…”

Volume of surgery for benign colorectal polyps in the last 11 years

“…Because the exact incidence of colorectal polyps was unknown, the relative volume changes in SR per year were calculated by dividing the annual nationwide volumes of SR performed for benign polyps by the annual nationwide volumes of colonoscopy. [21][22][23][24] This analysis was adapted from a recent study assessing the magnitude of radical rectal surgery performed in the Netherlands. 24 Other secondary outcome measures were a description of the endoscopic lesion characteristics, colonoscopy characteristics including endoscopic treatment attempts, surgical characteristics, and surgery-related morbidity and mortality for all SRs performed in the province of Noord-Holland.…”

Clinical and financial impacts of introducing an endoscopic mucosal resection service for treatment of patients with large colonic polyps into a regional tertiary hospital

“…No significant difference in rates of complete excision, complications, and recurrences has been found between EMR performed at high versus low volume centers 9 . Despite the findings of increased efficiency, reduced costs and decreased morbidity and mortality of EMR, surgery continues to be undertaken for a large number of endoscopically appropriate lesions 14 15 16 .…”