Pelican Cancer Foundation, Basingstoke, UK.
Basingstoke and North Hampshire Hospital, Basingstoke, UK.
Colorectal Dis. 2018 Dec;20(12):1088-1096. doi: 10.1111/codi.14342. Epub 2018 Aug 6.
The concept of significant polyps and early colorectal cancer (SPECC) encompasses complex polyps not amenable to routine snare polypectomy or where malignancy cannot be excluded. Surgical resection (SR) offers definitive treatment, but is overtreatment for the majority which are benign and amenable to less invasive endoscopic resection (ER). The aim of this study was to investigate variations in the management and outcomes of significant colorectal polyps.
This was a retrospective observational study of significant colorectal polyps, defined as nonpedunculated lesions of ≥ 20 mm size, diagnosed across nine UK hospitals in 2014. Inclusion criteria were endoscopically or histologically benign polyps at biopsy.
A total of 383 patients were treated by primary ER (87.2%) or SR (12.8%). Overall, 108/383 (28%) polyps were detected in the Bowel Cancer Screening Programme (BCSP). Primary SR was associated with a significantly longer length of stay and major complications (P < 0.01). Of the ER polyps, 290/334 (86.8%) patients were treated without undergoing surgery. The commonest indication for secondary surgery was unexpected polyp cancer, and of these cases 60% had no residual cancer in the specimen. Incidence of unexpected cancer was 10.7% (n = 41) and was similar between ER and SR groups (P = 0.11). On multivariate analysis, a polyp size of > 30 mm and non-BCSP status were independent risk factors for primary SR [OR 2.51 (95% CI 1.08-5.82), P = 0.03].
ER is safe and feasible for treating significant colorectal polyps. Robust accreditation within the BCSP has led to improvements in management, with lower rates of SR compared with non-BCSP patients. Standardization, training in polyp assessment and treatment within a multidisciplinary team may help to select appropriate treatment strategies and improve outcomes.
有意义息肉和早期结直肠癌（SPECC）的概念包括复杂的息肉，这些息肉不适于常规圈套息肉切除术，或恶性肿瘤不能排除。手术切除（SR）提供了明确的治疗方法，但对大多数良性息肉来说是过度治疗，这些息肉可以通过侵袭性较低的内镜下切除（ER）进行治疗。本研究旨在探讨有意义结直肠息肉的治疗方法和结果的差异。
这是一项对 2014 年在英国 9 家医院诊断的有意义结直肠息肉的回顾性观察性研究，这些息肉的定义是非蒂状病变，大小≥20mm。纳入标准为内镜或组织学活检证实为良性息肉。
共有 383 例患者接受了主要 ER（87.2%）或 SR（12.8%）治疗。总体而言，383 例患者中有 108 例（28%）息肉在结直肠癌筛查计划（BCSP）中发现。与 SR 相比，SR 与更长的住院时间和严重并发症显著相关（P<0.01）。在 ER 切除的息肉中，334 例患者中有 290 例（86.8%）无需手术治疗。二次手术最常见的指征是意外息肉癌变，其中 60%的病例标本中无残留癌。意外癌的发生率为 10.7%（n=41），在 ER 和 SR 组之间无差异（P=0.11）。多因素分析显示，息肉大小>30mm 和非 BCSP 状态是 SR 的独立危险因素[比值比 2.51（95%可信区间 1.08-5.82），P=0.03]。
ER 治疗有意义的结直肠息肉是安全可行的。BCSP 内严格的认证导致管理的改善，与非 BCSP 患者相比，SR 的比率较低。在多学科团队中，对息肉评估和治疗的标准化、培训，可能有助于选择合适的治疗策略，改善预后。
