Institute for Health Care Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
Cancer Program, Institute for Clinical Evaluative Sciences, Toronto, Canada.
J Med Screen. 2021 Sep;28(3):261-267. doi: 10.1177/0969141320967960. Epub 2020 Nov 5.
Colonoscopy following positive fecal occult blood screening may detect non-malignant polyps deemed to require major large bowel resection. We aimed to estimate the major inpatient morbidity and mortality associated with major resection of non-malignant polyps detected at colonoscopy following positive guaiac fecal occult blood screening in Ontario's population-based colorectal screening program.
We identified those without a diagnosis of colorectal cancer in the Ontario Cancer Registry ≤24 months following the date of colonoscopy prompted by positive fecal occult blood screening between 2008 and 2017, who underwent a major large bowel resection ≤24 months after the colonoscopy, with a diagnosis code for non-malignant polyp, in the absence of a code for any other large bowel diagnosis. We extracted records of major inpatient complications and readmissions ≤30 days following resection. We computed mortality within 90 days following resection.
For those undergoing colonoscopy ≤6 months following positive guaiac fecal occult blood screening, 420/127,872 (0.03%) underwent major large bowel resection for a non-malignant polyp. In 50/420 (11.9%), the resection included one or more rectosigmoid or rectal polyps, with or without a colonic polyp. There were one or more major inpatient complications or readmissions within 30 days in 117/420 (27.9%). Death occurred within 90 days in 6/420 (1.4%).
Serious inpatient complications and readmissions following major large bowel resection for non-malignant colorectal polyps are common, but mortality ≤90 days following resection is low. These outcomes should be considered as unintended adverse consequences of population-based colorectal screening programs.
在基于人群的结直肠筛查项目中，阳性粪便潜血筛查后行结肠镜检查可能会发现需要进行大肠主要切除术的非恶性息肉。本研究旨在评估在安大略省基于人群的结直肠筛查计划中，阳性愈创木脂粪便潜血筛查后行结肠镜检查时发现的非恶性息肉进行主要大肠切除术后，与主要住院发病率和死亡率相关的因素。
我们确定了在 2008 年至 2017 年期间，在阳性粪便潜血筛查后进行结肠镜检查的 24 个月内，安大略省癌症登记处没有结直肠癌诊断的人群，他们在结肠镜检查后 24 个月内接受了大肠主要切除术，且诊断编码为非恶性息肉，在没有任何其他大肠诊断编码的情况下。我们提取了切除术后 30 天内主要住院并发症和再入院的记录。我们计算了切除术后 90 天内的死亡率。
在接受阳性愈创木脂粪便潜血筛查后≤6 个月的患者中，有 420/127872（0.03%）例因非恶性息肉行大肠主要切除术。在 420 例患者中，有 50 例（11.9%）患者的切除范围包括一个或多个直肠乙状结肠或直肠息肉，伴或不伴结肠息肉。在 420 例患者中，有 117 例（27.9%）患者在 30 天内发生了一种或多种主要住院并发症或再入院。在 420 例患者中，有 6 例（1.4%）患者在切除术后 90 天内死亡。
非恶性结直肠息肉行大肠主要切除术后出现严重的住院并发症和再入院的情况较为常见，但切除术后 90 天内的死亡率较低。这些结果应被视为基于人群的结直肠筛查项目的非预期不良后果。
