Multicentre study of surgical referral and outcomes of patients with benign colorectal lesions

Abstract

BackgroundA multicentre cohort study was performed to analyse the motivations for surgical referral of patients with benign colorectal lesions, and to evaluate the endoscopic and pathological characteristics of these lesions as well as short‐term surgical outcomes.MethodsPatients who underwent surgery for a benign colorectal lesion in 15 Dutch hospitals between January 2014 and December 2017 were selected from the pathology registry. Lesions were defined as complex when at least one of the following features was present: size at least 40 mm, difficult location according to the endoscopist, previous failed attempt at resection, or non‐lifting sign.ResultsA total of 358 patients were included (322 colonic and 36 rectal lesions). The main reasons for surgical referral of lesions in the colon and rectum were large size (33·5 and 47 per cent respectively) and suspicion of invasive growth (31·1 and 58 per cent). Benign lesions could be categorized as complex in 80·6 per cent for colonic and 80 per cent for rectal locations. Surgery consisted of local excision in 5·9 and 64 per cent of colonic and rectal lesions respectively, and complicated postoperative course rates were noted in 11·2 and 3 per cent. In the majority of patients, no attempt was made to resect the lesion endoscopically (77·0 per cent of colonic and 83 per cent of rectal lesions).ConclusionThe vast majority of the benign lesions referred for surgical resection could be classified as complex. Considering the substantial morbidity of surgery for benign colonic lesions, reassessment for endoscopic resection by another advanced endoscopy centre seems to be underused and should be encouraged.

Impact of screening on short-term mortality and morbidity following treatment for colorectal cancer

“…However, 90 days mortality, which is a better marker for postoperative mortality, has not been used previously in screening literature (6,8,14,15,23). We also found that more patients could be treated with curative intent in the screened group, more could be treated with endoscopic resections, and that emergency surgery was almost eliminated in the screening group which is also new compared to other studies (8,(24)(25)(26). This is important as emergency treatment is associated with high mortality rates and morbidity rates (17,18,27), whereas endoscopic treatment is associated with lower mortality and morbidity compared with surgery (15,28).…”

“…6,8,14,15,23 We also found that more patients could be treated with curative intent in the screened group, more could be treated with endoscopic resections, and that emergency surgery was almost eliminated in the screening group which is also new compared to other studies. 8,[24][25][26] This is important as emergency treatment is associated with high mortality rates and morbidity rates 17,18,27 , whereas endoscopic treatment is associated with lower mortality and morbidity compared with surgery. 15,28 The methodological limitations of this study include a setup that leaves room for selection bias and healthy user bias.…”

pT1 Colorectal Cancer Detected in a Colorectal Cancer Mass Screening Program: Treatment and Factors Associated with Residual and Extraluminal Disease

“…In this sense, we have evaluated the SMSA classification for the first time in the pT1 CRC confirming that it fairly discriminates which lesions are candidates for endoscopic resection. SMSA was first described by Gupta et al [26] and has confirmed in several studies its ability to identify which lesions are challenging [27,28]. In this sense, it is relevant to improve the resection skills of the endoscopists in order to evaluate which lesions are at risk of harboring an invasive CRC candidate for endoscopic resection and, in any case, obtain a complete endoscopic resection according to the characteristics of the lesion.…”

Evaluation of polypectomy quality indicators of large nonpedunculated colorectal polyps in a nonexpert, bowel cancer screening cohort

“…and clinical success rates for endoscopic resection were 87% (95% CI, 82-91) and 87% (95% CI, 80-92), respectively. Cumulative recurrence rates after 12 months were 22% (95% CI, 15-32) after piecemeal resection and 8% (95% CI, 2-22) after en-bloc resection, and adverse events occurred in 5% of cases (95% CI, [3][4][5][6][7][8][9]. The primary surgery referral rate for noninvasive LNPCPs was 7% (95% CI, 5-10).…”

“…Current evidence suggests there is still room for improvement regarding quality of endoscopic care for LNPCPs, because recurrence after EMR is significant, 6 compliance with surveillance guidelines is suboptimal, 7 and noninvasive LNPCPs are frequently referred for surgery. 8,9 Although expert centers have reported their outcomes of EMRs performed on LNPCPs, little is known regarding these outcomes in a screening setting. In this performance of 2 substudies, we evaluated the quality of endoscopic care for LNPCPs in the Dutch BCSP.…”