Outcomes of complex colorectal polyps managed by multi-disciplinary team strategies—a multi-centre observational study

Abstract

Purpose Team management strategies for complex colorectal polyps are recommended by professional guidelines. Multi-disciplinary meetings are used across the UK with limited information regarding their impact. The aim of this multi-centre observational study was to assess procedures and outcomes of patients managed using these approaches. Method This was a retrospective, observational study of patients managed by six UK sites. Information was collected regarding procedures and outcomes including length of stay, adverse events, readmissions and cancers. Results Two thousand one hundred ninety-two complex polyps in 2109 patients were analysed with increasing referrals annually. Most presented symptomatically and the mean polyp size was 32.1 mm. Primary interventions included endoscopic therapy (75.6%), conservative management (8.3%), colonic resection (8.1%), trans-anal surgery (6.8%) or combined procedures (1.1%). The number of primary colonic resections decreased over the study period without a reciprocal increase in secondary procedures or recurrence. Secondary procedures were required in 7.8%. The median length of stay for endoscopic procedures was 0 days with 77.5% completed as day cases. Median length of stay was 5 days for colonic resections. Overall adverse event and 30-day readmission rates were 9.0% and 3.3% respectively. Malignancy was identified in 8.8%. Benign polyp recurrence occurred in 13.1% with a median follow up of 30.4 months. Screening detected lesions were more likely to undergo bowel resection. Colonic resection was associated with longer stays, higher adverse events and more cancers on final histology. Conclusion Multi-disciplinary team management of complex polyps is safe and effective. Standardisation of organisation and quality monitoring is needed to continue positive effects on outcomes and services.

Local radical treatment of pathological lesions of the rectum with minimally invasive surgical approaches

“…The low frequency of postoperative complications, even in our small patient series, justifies the introduction of the TAMIS procedure into daily practice for the surgical management of large endoscopically unresectable rectal polyps located high in the rectum, in line with other studies 27,28 . The simultaneous low percentage of recurrences and malignant alterations after polyp resection, according to the literature, only confirms our assertion 29 .…”

“…Ovako mala učestalost postoperativnih komplikacija, čak i u ovoj našoj maloj seriji pacijenata, opravdava uvođenje TA-MIS procedure u svakodnevnu praksu za hirurško rešavanje velikih endoskopski neresektabilnih rektalnih polipa visoke rektalne lokalizacije, u skladu sa drugim studijama 27,28 . Istovremeno mali procenat recidiva i maligne alteracije posle resekcije polipa, po literaturnim podacima, samo potvrđuje ovu našu tvrdnju 29 .…”

Planning management for complex colorectal polyps: a qualitative assessment of factors influencing decision-making among colonoscopists

“…Surgeons may still recommend resection despite correctly identifying a polyp as benign,12 suggesting service-related factors may also be influential. The use of team approaches to decision-making may reduce the utilisation of colonic resection,14 but these are not available in all centres. Shared decision- making should also be considered, with importance demonstrated regarding the management of malignant polyps 15.…”

“…Surgeons may still recommend resection despite correctly identifying a polyp as benign, 12 suggesting service-related factors may also be influential. The use of team approaches to decisionmaking may reduce the utilisation of colonic resection, 14 but these are not available in all centres. Shared decision-making should also WHAT IS ALREADY KNOWN ON THIS TOPIC ⇒ The treatment of complex colorectal polyps is variable but the underlying factors for this at an individual clinician level are not understood.…”