Departments of Surgery, Tennessee Valley Healthcare System, Veterans Health Administration, Nashville, TN; Geriatric Research and Education Clinical Center, Tennessee Valley Healthcare System, Veterans Health Administration, Nashville, TN; Departments of Surgery, Vanderbilt University Medical Center, Nashville, TN.
Department of Surgery, Moffitt Cancer Center and Research Institute, Tampa, FL.
J Am Coll Surg. 2020 Aug;231(2):257-266. doi: 10.1016/j.jamcollsurg.2020.05.011. Epub 2020 May 23.
Although endoscopy is recommended at 1 year after colorectal cancer (CRC) resection to detect locally recurrent CRC, earlier work at our Veterans Affairs (VA) facility demonstrated that 35% of patients achieve this metric.
The interdisciplinary team used quality improvement methods to standardize processes and implement a gastroenterology-managed virtual surveillance clinic. The intervention clinic was implemented in August 2014. Veterans who underwent resection for stage I to III CRC at a single VA facility from January 2010 to December 2017 were included, with those undergoing resection between January 2010 and July 2014 considered pre-intervention and those undergoing resection between August 2014 and December 2017 considered post-intervention. The primary endpoint was the proportion of eligible patients for whom endoscopy was completed within 1 year of resection. Secondary outcomes were the proportion of patients who completed endoscopy within 18 months of resection or at any time post-resection and time to surveillance endoscopy.
A total of 186 patients underwent resection for stage I to III CRC from 2010 to 2017; of these, 160 (86%) were eligible for endoscopy at 1-year post-resection (98 pre-intervention and 62 post-intervention). In the pre-intervention period, 30 of 98 patients (30.6%) underwent surveillance endoscopy within 1 year vs 31 of 62 (50.0%) post-intervention (p = 0.031). When evaluated at 18 months after resection, 56 of 98 patients (57.1%) in the pre-intervention group vs 52 of 62 (83.9%) in the post-intervention group underwent surveillance endoscopy (p = 0.001). Median time from resection to endoscopy decreased during the study period, from 1.19 years pre-intervention (interquartile range 0.93 to 1.74 years) to 1.0 years post-intervention (interquartile range 0.93 to 1.09 years) (p = 0.006).
Implementation of a virtual surveillance clinic with standardized processes was associated with increased guideline-concordant endoscopic surveillance after CRC resection.
尽管内镜检查被推荐用于结直肠癌（CRC）切除术后 1 年，以检测局部复发性 CRC，但我们退伍军人事务部（VA）的早期研究表明，35%的患者达到了这一标准。
多学科团队采用质量改进方法来规范流程并实施胃肠病学管理的虚拟监测诊所。干预诊所于 2014 年 8 月实施。从 2010 年 1 月至 2017 年 12 月，在单个 VA 机构接受 I 期至 III 期 CRC 切除术的退伍军人被纳入研究，其中 2010 年 1 月至 2014 年 7 月接受切除术的患者被认为是干预前组，2014 年 8 月至 2017 年 12 月接受切除术的患者被认为是干预后组。主要终点是在切除术后 1 年内完成内镜检查的合格患者比例。次要结果是在切除术后 18 个月或任何时间内完成内镜检查的患者比例和监测内镜检查的时间。
共有 186 例患者在 2010 年至 2017 年间接受 I 期至 III 期 CRC 切除术；其中 160 例（86%）在术后 1 年时适合行内镜检查（98 例为干预前组，62 例为干预后组）。在干预前组中，98 例患者中有 30 例（30.6%）在 1 年内接受了监测性内镜检查，而 62 例患者中有 31 例（50.0%）在干预后组（p=0.031）。在切除术后 18 个月时，98 例患者中有 56 例（57.1%）在干预前组，62 例患者中有 52 例（83.9%）在干预后组接受了监测性内镜检查（p=0.001）。在研究期间，从切除到内镜检查的中位时间缩短，干预前组为 1.19 年（四分位距 0.93 至 1.74 年），干预后组为 1.0 年（四分位距 0.93 至 1.09 年）（p=0.006）。
实施具有标准化流程的虚拟监测诊所与 CRC 切除术后更符合指南的内镜监测相关。
