Department of Surgery, Isala, Zwolle, The Netherlands.
Department of Gastroenterology and Hepatology, Isala, Zwolle, The Netherlands.
Colorectal Dis. 2021 Mar;23(3):672-679. doi: 10.1111/codi.15413. Epub 2020 Nov 11.
Implementation of the Dutch national bowel screening programme in 2014 led to an increased rate of detection of polyps. In general, polyps should be removed endoscopically. However, if the size and location of the polyp make endoscopic removal technically difficult, or if there is a suspicion for early (T1) cancer, surgery is the preferred method for removal. An increasing number of these patients are being treated with minimally invasive surgical procedures instead of segmental resection. The aim of this study was to assess the number of referrals for surgery and the type of surgery for polyps since the introduction of the Dutch national bowel screening programme.
A retrospective cohort study was performed. Patients who underwent surgery for colorectal polyps between January 2012 and December 2017 were included. Patients with histologically proven carcinoma prior to surgery were excluded. Primary outcomes were the number and type of surgical procedures for polyps.
A total of 164 patients were included. An annual increase in procedures for colorectal polyps was observed, from 18 patients in 2012 to 36 patients in 2017. All the procedures before implementation of the screening programme were segmental resections, and 58.8% of the patients underwent organ-preserving surgery after implementation of the screening. The overall complication rate of organ-preserving surgery was 16.3%, compared with 44.3% for segmental resections (P = 0.001). Overall, invasive colorectal cancer was encountered in 23.8% of cases.
The number of referrals for surgical resection of colorectal polyps has doubled since the introduction of the Dutch national bowel screening programme with a substantial shift towards organ-preserving techniques.
2014 年荷兰全国结直肠筛查项目的实施导致息肉检出率增加。一般来说，息肉应在内镜下切除。然而，如果息肉的大小和位置使得内镜切除技术上困难，或者如果怀疑有早期（T1）癌症，手术是首选的切除方法。越来越多的此类患者接受微创外科手术治疗，而非节段切除术。本研究旨在评估自荷兰全国结直肠筛查项目实施以来，因息肉而行手术治疗的患者数量和手术类型。
本研究为回顾性队列研究。纳入 2012 年 1 月至 2017 年 12 月期间因结直肠息肉而行手术治疗的患者。排除术前经组织学证实为癌的患者。主要结局指标为息肉手术的数量和类型。
共纳入 164 例患者。观察到结直肠息肉手术数量逐年增加，从 2012 年的 18 例增加到 2017 年的 36 例。在实施筛查项目之前，所有的手术均为节段切除术，而在实施筛查项目后，58.8%的患者接受了保留器官的手术。保留器官手术的总体并发症发生率为 16.3%，而节段切除术为 44.3%（P=0.001）。总体而言，浸润性结直肠癌的发生率为 23.8%。
自荷兰全国结直肠筛查项目实施以来，因结直肠息肉而行外科切除的转诊数量增加了一倍，且大量患者倾向于采用保留器官的技术。
