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Overutilization of surgical resection for benign colorectal polyps: analysis from a tertiary care center

Background and study aims  Adequate removal of precancerous polyps is an independent factor in colorectal cancer prevention. Despite advances in polypectomy techniques, there is an increasing rate of surgery for benign polyps. We assessed whether surgical resection is properly utilized for benign co...

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Autores principales: Saade, Rayan, Tsang, Tyler, Kmeid, Michel, Miller, David, Fu, Zhiyan, Litynski, James, Young, Patrick, Anderson, Joseph C., Lee, Hwajeong, Tadros, Micheal
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Georg Thieme Verlag KG 2021
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8062229/
https://www.ncbi.nlm.nih.gov/pubmed/33937512
http://dx.doi.org/10.1055/a-1380-3017
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author Saade, Rayan
Tsang, Tyler
Kmeid, Michel
Miller, David
Fu, Zhiyan
Litynski, James
Young, Patrick
Anderson, Joseph C.
Lee, Hwajeong
Tadros, Micheal
author_facet Saade, Rayan
Tsang, Tyler
Kmeid, Michel
Miller, David
Fu, Zhiyan
Litynski, James
Young, Patrick
Anderson, Joseph C.
Lee, Hwajeong
Tadros, Micheal
author_sort Saade, Rayan
collection PubMed
description Background and study aims  Adequate removal of precancerous polyps is an independent factor in colorectal cancer prevention. Despite advances in polypectomy techniques, there is an increasing rate of surgery for benign polyps. We assessed whether surgical resection is properly utilized for benign colorectal polyps. Patients and methods  We identified 144 patients with surgical resection for benign colorectal polyps. Polyp location, size and the indication for and type of surgery were obtained. For the purposes of this analysis, we assumed that gastroenterologists should assess polyp size accurately, endoscopically resect polyps < 2 cm, and treat incompletely excised polyps on follow-up. Results  A total of 118 patients (82 %) were referred to surgery without attempted endoscopic removal. In 26 (22 %) of 118, the macroscopic polyp size was < 2 cm (23 in right, 3 in the left colon) and 18 (15 %; 14 in the right, four in the left colon) were found to have had size overestimation during endoscopy. Twenty-two (15 %) of 144 underwent surgical resection for incomplete endoscopic resection of adenomas (16 in the right, 6 in the left colon); 12 (54.5 %) had a residual polyp size of < 2 cm (10 in the right colon; 2 in the left colon). In-hospital mortality was 0.7 % and morbidity was 20.1 %. Conclusions  Of the patients, 41 % could have potentially avoided surgical intervention (37 polyps < 2 cm and/or size overestimations precluding endoscopic polypectomy and 22 incomplete resections). When including polyps with size ≥ 2 to < 4 cm, the percentage of patients with avoidable surgery reached 80 %. This confirms the need to develop standardized quality metrics for endoscopic polypectomies and for better overall training of endoscopists performing these procedures. Given the risks of surgery, referral to an experienced gastroenterologist should be considered as a first step.
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spelling pubmed-80622292021-05-01 Overutilization of surgical resection for benign colorectal polyps: analysis from a tertiary care center Saade, Rayan Tsang, Tyler Kmeid, Michel Miller, David Fu, Zhiyan Litynski, James Young, Patrick Anderson, Joseph C. Lee, Hwajeong Tadros, Micheal Endosc Int Open Background and study aims  Adequate removal of precancerous polyps is an independent factor in colorectal cancer prevention. Despite advances in polypectomy techniques, there is an increasing rate of surgery for benign polyps. We assessed whether surgical resection is properly utilized for benign colorectal polyps. Patients and methods  We identified 144 patients with surgical resection for benign colorectal polyps. Polyp location, size and the indication for and type of surgery were obtained. For the purposes of this analysis, we assumed that gastroenterologists should assess polyp size accurately, endoscopically resect polyps < 2 cm, and treat incompletely excised polyps on follow-up. Results  A total of 118 patients (82 %) were referred to surgery without attempted endoscopic removal. In 26 (22 %) of 118, the macroscopic polyp size was < 2 cm (23 in right, 3 in the left colon) and 18 (15 %; 14 in the right, four in the left colon) were found to have had size overestimation during endoscopy. Twenty-two (15 %) of 144 underwent surgical resection for incomplete endoscopic resection of adenomas (16 in the right, 6 in the left colon); 12 (54.5 %) had a residual polyp size of < 2 cm (10 in the right colon; 2 in the left colon). In-hospital mortality was 0.7 % and morbidity was 20.1 %. Conclusions  Of the patients, 41 % could have potentially avoided surgical intervention (37 polyps < 2 cm and/or size overestimations precluding endoscopic polypectomy and 22 incomplete resections). When including polyps with size ≥ 2 to < 4 cm, the percentage of patients with avoidable surgery reached 80 %. This confirms the need to develop standardized quality metrics for endoscopic polypectomies and for better overall training of endoscopists performing these procedures. Given the risks of surgery, referral to an experienced gastroenterologist should be considered as a first step. Georg Thieme Verlag KG 2021-05 2021-04-22 /pmc/articles/PMC8062229/ /pubmed/33937512 http://dx.doi.org/10.1055/a-1380-3017 Text en The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.
spellingShingle Saade, Rayan
Tsang, Tyler
Kmeid, Michel
Miller, David
Fu, Zhiyan
Litynski, James
Young, Patrick
Anderson, Joseph C.
Lee, Hwajeong
Tadros, Micheal
Overutilization of surgical resection for benign colorectal polyps: analysis from a tertiary care center
title Overutilization of surgical resection for benign colorectal polyps: analysis from a tertiary care center
title_full Overutilization of surgical resection for benign colorectal polyps: analysis from a tertiary care center
title_fullStr Overutilization of surgical resection for benign colorectal polyps: analysis from a tertiary care center
title_full_unstemmed Overutilization of surgical resection for benign colorectal polyps: analysis from a tertiary care center
title_short Overutilization of surgical resection for benign colorectal polyps: analysis from a tertiary care center
title_sort overutilization of surgical resection for benign colorectal polyps: analysis from a tertiary care center
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8062229/
https://www.ncbi.nlm.nih.gov/pubmed/33937512
http://dx.doi.org/10.1055/a-1380-3017
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