Department of Colorectal Surgery, Cheltenham General Hospital, Cheltenham, UK.
Colorectal Dis. 2013 Mar;15(3):292-7. doi: 10.1111/j.1463-1318.2012.03173.x.
The inappropriate use of the '2-week wait' pathway for suspected colorectal cancer (CRC2ww) may overload urgent clinics and delay the assessment and investigation of other patients. Those who have been previously referred and investigated for suspected colorectal cancer may present one group that does not warrant repeat urgent referral. This paper aims to identify the incidence and diagnostic yield of repeat CRC2ww referrals.
All CRC2ww patients referred to our unit over a 4-year period were identified retrospectively. Referral indication, outcome and instances of repeat referral were identified from multidisciplinary team, endoscopy and imaging databases.
In all, 2735 CRC2ww referrals were made over the study period. Of these, 122 were repeated CRC2ww referrals, with the incidence increasing from 2% in 2008 to 6% in 2010 (P = 0.0006). The median time to repeat referral was 1070 days. After initial referral 267 cancers were detected, including 212 colorectal cancers. The diagnostic yield was lower but not significantly so after repeated referral (six cancers) compared with initial referral (5%vs 10%, P = 0.07).
The incidence of repeat referral is low but the diagnostic yield is not insignificant. Exclusion of these patients from urgent assessment and investigation will not significantly reduce workload and may risk missing some patients with cancer.
不恰当地将疑似结直肠癌（CRC2ww）的“2 周等待”途径用于疑似结直肠癌（CRC2ww）可能会使紧急诊所不堪重负，并延迟对其他患者的评估和检查。那些以前因疑似结直肠癌而被转诊和检查的患者可能属于一组不需要重复紧急转诊的患者。本文旨在确定重复 CRC2ww 转诊的发生率和诊断率。
回顾性地确定了在 4 年期间向我们科室转诊的所有 CRC2ww 患者。从多学科团队、内窥镜和影像学数据库中确定了转诊指征、结果和重复转诊的情况。
在研究期间共进行了 2735 次 CRC2ww 转诊。其中 122 次为重复 CRC2ww 转诊，其发生率从 2008 年的 2%增加到 2010 年的 6%（P = 0.0006）。重复转诊的中位数时间为 1070 天。初次转诊后发现 267 例癌症，包括 212 例结直肠癌。重复转诊后的诊断率虽然较低，但无统计学意义（6 例癌症）与初次转诊（5%比 10%，P = 0.07）相比。
重复转诊的发生率虽然较低，但诊断率却不容忽视。将这些患者排除在紧急评估和检查之外，不会显著减少工作量，并且可能会错过一些患有癌症的患者。
