Department of Internal Medicine, University of Florida, Gainesville, Florida, USA.
College of Medicine, University of Florida, Gainesville, Florida, USA.
Gastrointest Endosc. 2020 Sep;92(3):702-711.e2. doi: 10.1016/j.gie.2020.04.041. Epub 2020 Apr 22.
The incidence of surgery for nonmalignant colorectal polyps is rising. The aims of this study were to evaluate referral patterns to surgery for nonmalignant polyps, to compare outcomes between surgery and endoscopic resection (ER), and to identify factors associated with surgery in a university-based, tertiary care center.
Patients referred to colorectal surgery (CRS) for nonmalignant colorectal polyps between 2014 and 2019 were selected from the institution's integrated data repository. Clinical characteristics were obtained through chart review. Multivariate analysis was performed to identify factors associated with surgery for nonmalignant polyps.
Six hundred sixty-four patients with colorectal lesions were referred to CRS, of which 315 were for nonmalignant polyps. Most referrals (69%) came from gastroenterologists. Of the 315 cases, 136 underwent surgery and 117 were referred for attempt at ER. Complete ER was achieved in 87.2% (n = 102), with polyp recurrence in 27.2% at a median of 14 months (range, 0-72). When compared with surgery, ER was associated with a lower hospitalization rate (22.2% vs 95.6%; P < .0001), shorter hospital stay (mean, .5 ± .9 vs 2.23 ± 1 days; P < .0001), and fewer adverse events (5.9% vs 22.8%; P = .0002). Intramucosal adenocarcinoma on baseline pathology (odds ratio, 5.7; 95% confidence interval, 1.2-28.2) and referrals by academic gastroenterologists (odds ratio, 2.5; 95% confidence interval, 1.11-5.72) were associated with a higher likelihood of surgery on multivariate analysis.
Gastroenterologists commonly refer nonmalignant colorectal polyps to surgery, even though ER is effective and associated with lower morbidity. Both referrals from academic gastroenterologists and baseline pathology of intramucosal adenocarcinoma were factors associated with surgery. All colorectal polyps should be evaluated in a multidisciplinary approach to identify lesions suitable for ER before embarking in surgery.
非恶性结直肠息肉手术的发病率正在上升。本研究旨在评估非恶性息肉手术的转诊模式，比较手术与内镜下切除（ER）的结果，并在一个以大学为基础的三级保健中心确定与手术相关的因素。
从机构的综合数据存储库中选择 2014 年至 2019 年因非恶性结直肠息肉而转至结直肠外科（CRS）的患者。通过病历回顾获取临床特征。进行多变量分析以确定与非恶性息肉手术相关的因素。
664 例结直肠病变患者被转至 CRS，其中 315 例为非恶性息肉。大多数（69%）转诊来自胃肠病学家。在 315 例患者中，136 例行手术，117 例转至 ER 尝试。87.2%（n=102）患者完全行 ER，中位随访 14 个月（范围，0-72 个月）时有 27.2%的患者息肉复发。与手术相比，ER 与较低的住院率（22.2% vs. 95.6%；P<.0001）、较短的住院时间（平均，0.5±0.9 vs. 2.23±1 天；P<.0001）和较少的不良事件（5.9% vs. 22.8%；P=.0002）相关。基线病理的黏膜内腺癌（比值比，5.7；95%置信区间，1.2-28.2）和学术型胃肠病学家的转诊（比值比，2.5；95%置信区间，1.11-5.72）与多变量分析中手术的可能性增加相关。
即使 ER 有效且与较低的发病率相关，胃肠病学家仍常将非恶性结直肠息肉转至手术治疗。学术型胃肠病学家的转诊和黏膜内腺癌的基线病理是与手术相关的因素。所有结直肠息肉均应通过多学科方法进行评估，以确定适合 ER 的病变，然后再行手术。
