Referrals for surgical removal of polyps since the introduction of a colorectal cancer screening programme

Abstract

Aim: Implementation of the Dutch national bowel screening programme in 2014 led to an increased rate of detection of polyps. In general, polyps should be removed endoscopically. However, if the size and location of the polyp make endoscopic removal technically difficult, or if there is a suspicion for early (T1) cancer, surgery is the preferred method for removal. An increasing number of these patients are being treated with minimally invasive surgical procedures instead of segmental resection. The aim of this study was to assess the number of referrals for surgery and the type of surgery for polyps since the introduction of the Dutch national bowel screening programme. Method: A retrospective cohort study was performed. Patients who underwent surgery for colorectal polyps between January 2012 and December 2017 were included. Patients with histologically proven carcinoma prior to surgery were excluded. Primary outcomes were the number and type of surgical procedures for polyps. Results: A total of 164 patients were included. An annual increase in procedures for colorectal polyps was observed, from 18 patients in 2012 to 36 patients in 2017. All the procedures before implementation of the screening programme were segmental resections, and 58.8% of the patients underwent organ-preserving surgery after implementation of the screening. The overall complication rate of organ-preserving surgery was 16.3%, compared with 44.3% for segmental resections (P = 0.001). Overall, invasive colorectal cancer was encountered in 23.8% of cases. Conclusion: The number of referrals for surgical resection of colorectal polyps has doubled since the introduction of the Dutch national bowel screening programme with a substantial shift towards organ-preserving techniques.

Colonoscopic-Assisted Laparoscopic Wedge Resection for Colonic Lesions

“…The number of advanced adenomas early T1 cancers with referrals for surgical treatment of these lesions has increased substantially due to the implementation of national CRC screening programs in many countries. 3 CAL-WR seems to fill the gap between endoscopic resection and more advanced surgical procedures, which are accompanied by higher morbidity (24%) and mortality (2%) rates. 13 In the present study only 11% of patients underwent additional oncological segmental resection, indicating that segmental colectomy could be prevented in all other cases.…”

“…B ecause the implementation of a nationwide colorectal screening program in the Netherlands in 2014, the incidence of advanced adenomas and early-stage colorectal cancer (CRC) and the number of patients referred for colorectal resection for high grade polyps has increased. [1][2][3] Endoscopic polypectomy is a well-established treatment for noninvasive colonic polyps, 4 the majority of which can be removed safely with standard polypectomy. For more challenging polyps advanced endoscopic techniques such as endoscopic mucosal resection (EMR), endoscopic submucosal dissection, and endoscopic full-thickness resection (eFTR) have improved local resectability compared with standard polypectomy.…”

“…Because the implementation of a nationwide colorectal screening program in the Netherlands in 2014, the incidence of advanced adenomas and early-stage colorectal cancer (CRC) and the number of patients referred for colorectal resection for high grade polyps has increased 1–3 . Endoscopic polypectomy is a well-established treatment for noninvasive colonic polyps, 4 the majority of which can be removed safely with standard polypectomy.…”

Colonoscopic‐assisted laparoscopic wedge resection versus segmental colon resection for benign colonic polyps: a comparative cost analysis

“…Since the implementation of the national bowel cancer screening programme, the number of surgical referrals for benign polyps has tripled [11], whilst at the same time colorectal cancer is more frequently detected at an earlier stage and also the armamentarium of advanced endoscopic (combined with laparoscopic) techniques has expanded, both resulting in a shift to a more common use of local resection techniques [12][13][14]. Combined endoscopic laparoscopic surgery techniques, such as the colonoscopic-assisted laparoscopic wedge resection (CAL-WR), can be used to treat patients with endoscopic unresectable benign colonic polyps [15][16][17][18][19].…”