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The impact of the national bowel screening program in the Netherlands on detection and treatment of endoscopically unresectable benign polyps

BACKGROUND: In January 2014, a national bowel cancer screening program started in the Netherlands. The program is being implemented in phases until 2019. Due to this program, an increase in patients referred for a colorectal resection for benign, but endoscopically unresectable polyps, is expected....

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Autores principales: Marres, C. C. M., Buskens, C. J., Schriever, E., Verbeek, P. C. M., Mundt, M. W., Bemelman, W. A., van de Ven, A. W. H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5700986/
https://www.ncbi.nlm.nih.gov/pubmed/29149427
http://dx.doi.org/10.1007/s10151-017-1705-x
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author Marres, C. C. M.
Buskens, C. J.
Schriever, E.
Verbeek, P. C. M.
Mundt, M. W.
Bemelman, W. A.
van de Ven, A. W. H.
author_facet Marres, C. C. M.
Buskens, C. J.
Schriever, E.
Verbeek, P. C. M.
Mundt, M. W.
Bemelman, W. A.
van de Ven, A. W. H.
author_sort Marres, C. C. M.
collection PubMed
description BACKGROUND: In January 2014, a national bowel cancer screening program started in the Netherlands. The program is being implemented in phases until 2019. Due to this program, an increase in patients referred for a colorectal resection for benign, but endoscopically unresectable polyps, is expected. So far, most resections are performed according to oncological principles despite no pre-operative histological diagnosis of malignancy. The aim of this study was to analyze the increase in referred patients during the first year of the screening program and to compare pathological results and clinical outcome of resections of patients undergoing resection for benign polyps before and after implementation of screening. METHODS: Patients referred for colorectal resection without biopsy-proven cancer between January 2009 and January December 2014 were identified from a prospectively maintained database. Patients with endoscopically macroscopic features of carcinoma were excluded. RESULTS: Seventy-six patients were included. Forty-seven patients (61.8%) were operated on in the 5 years prior to implementation of the screening program, and 29 patients (38.2%) were operated during the first year of implementation of the screening program. The overall malignancy rate before the introduction of the program was 14.1 and 6.6% after it had started (p = .469). All resections were performed laparoscopically; the conversion rate was 3.9% (n = 3). The overall mortality rate was 2.7% (n = 2), major complications (Clavien–Dindo > 3b) occurred in 11.8% (n = 9) of patients. The anastomotic leakage rate was 3.9% (n = 3). CONCLUSIONS: The number of patients referred for benign polyps tripled after introduction of the screening program. With an overall major morbidity and mortality rate of 11.8%, it seems valid to discuss whether an endoscopic excision with advanced techniques with or without laparoscopic assistance would be preferable in this patient group, accepting a 6.6% reoperation rate for additional oncological resection with lymph node sampling in patients in whom a malignancy is found on histological analysis of the complete polyp.
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spelling pubmed-57009862017-12-04 The impact of the national bowel screening program in the Netherlands on detection and treatment of endoscopically unresectable benign polyps Marres, C. C. M. Buskens, C. J. Schriever, E. Verbeek, P. C. M. Mundt, M. W. Bemelman, W. A. van de Ven, A. W. H. Tech Coloproctol Original Article BACKGROUND: In January 2014, a national bowel cancer screening program started in the Netherlands. The program is being implemented in phases until 2019. Due to this program, an increase in patients referred for a colorectal resection for benign, but endoscopically unresectable polyps, is expected. So far, most resections are performed according to oncological principles despite no pre-operative histological diagnosis of malignancy. The aim of this study was to analyze the increase in referred patients during the first year of the screening program and to compare pathological results and clinical outcome of resections of patients undergoing resection for benign polyps before and after implementation of screening. METHODS: Patients referred for colorectal resection without biopsy-proven cancer between January 2009 and January December 2014 were identified from a prospectively maintained database. Patients with endoscopically macroscopic features of carcinoma were excluded. RESULTS: Seventy-six patients were included. Forty-seven patients (61.8%) were operated on in the 5 years prior to implementation of the screening program, and 29 patients (38.2%) were operated during the first year of implementation of the screening program. The overall malignancy rate before the introduction of the program was 14.1 and 6.6% after it had started (p = .469). All resections were performed laparoscopically; the conversion rate was 3.9% (n = 3). The overall mortality rate was 2.7% (n = 2), major complications (Clavien–Dindo > 3b) occurred in 11.8% (n = 9) of patients. The anastomotic leakage rate was 3.9% (n = 3). CONCLUSIONS: The number of patients referred for benign polyps tripled after introduction of the screening program. With an overall major morbidity and mortality rate of 11.8%, it seems valid to discuss whether an endoscopic excision with advanced techniques with or without laparoscopic assistance would be preferable in this patient group, accepting a 6.6% reoperation rate for additional oncological resection with lymph node sampling in patients in whom a malignancy is found on histological analysis of the complete polyp. Springer International Publishing 2017-11-17 2017 /pmc/articles/PMC5700986/ /pubmed/29149427 http://dx.doi.org/10.1007/s10151-017-1705-x Text en © The Author(s) 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Article
Marres, C. C. M.
Buskens, C. J.
Schriever, E.
Verbeek, P. C. M.
Mundt, M. W.
Bemelman, W. A.
van de Ven, A. W. H.
The impact of the national bowel screening program in the Netherlands on detection and treatment of endoscopically unresectable benign polyps
title The impact of the national bowel screening program in the Netherlands on detection and treatment of endoscopically unresectable benign polyps
title_full The impact of the national bowel screening program in the Netherlands on detection and treatment of endoscopically unresectable benign polyps
title_fullStr The impact of the national bowel screening program in the Netherlands on detection and treatment of endoscopically unresectable benign polyps
title_full_unstemmed The impact of the national bowel screening program in the Netherlands on detection and treatment of endoscopically unresectable benign polyps
title_short The impact of the national bowel screening program in the Netherlands on detection and treatment of endoscopically unresectable benign polyps
title_sort impact of the national bowel screening program in the netherlands on detection and treatment of endoscopically unresectable benign polyps
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5700986/
https://www.ncbi.nlm.nih.gov/pubmed/29149427
http://dx.doi.org/10.1007/s10151-017-1705-x
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