Zammit Andrew P, Brown Ian, Hooper John D, Clark David A, Riddell Andrew D
Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
Envoi Specialist Pathologists, Brisbane, Queensland, Australia.
ANZ J Surg. 2023 Mar;93(3):606-611. doi: 10.1111/ans.18069. Epub 2022 Oct 3.
The management of malignant polyps presents a treatment challenge between a colorectal resection and polypectomy alone. Patients managed with polypectomy alone typically undergo surveillance for recurrent or metastatic disease, however, optimal timing of surveillance methods remains unclear. Guidelines recommend for completely resected malignant polyps, that a surveillance colonoscopy be perform 12 months from diagnosis. This study sought to clarify how patients with a malignant polyp were being colonoscopically surveilled if they did not undergo colorectal resection.
A retrospective, population-wide cohort analysis of all patients from 2011 to 2019 was performed using data from the Queensland Oncology Repository. Patient, procedural and pathological data were extracted for all patients diagnosed with a malignant polyp and timing of the first surveillance endoscopy was calculated. Statistical analysis comparing the timing of surveillance colonoscopy across multiple patients, procedural and histological characteristics were assessed.
A total of 1646 patients were identified with a malignant polyp, with 797 patients managed with polypectomy and surveillance alone. The median time to surveillance endoscopy was 182 days with the mean 220.01 days. This was substantially sooner than the recommended clinical guidelines of 365 days. There were no patient or procedural characteristics which predicted a difference in the timing of surveillance colonoscopy. No pathological factors appeared to change the timing for surveillance endoscopy (P > 0.05).
Overall, patients had surveillance endoscopy procedures substantially earlier than guideline recommendations. However, evidence underlying these guidelines and other surveillance methods for malignant polyps are not strong. Future technological developments, including improvements in imaging techniques, may provide additional options for surveillance of malignant polyps.
恶性息肉的治疗面临着结肠直肠切除术与单纯息肉切除术之间的抉择。仅接受息肉切除术治疗的患者通常需要接受复发性或转移性疾病的监测，然而，监测方法的最佳时机仍不明确。指南建议，对于完全切除的恶性息肉，应在诊断后12个月进行监测结肠镜检查。本研究旨在明确未接受结肠直肠切除术的恶性息肉患者是如何接受结肠镜监测的。
利用昆士兰肿瘤库的数据，对2011年至2019年的所有患者进行回顾性、全人群队列分析。提取所有诊断为恶性息肉患者的患者、手术和病理数据，并计算首次监测内镜检查的时间。评估了比较多名患者结肠镜监测时间、手术和组织学特征的统计分析。
共识别出1646例恶性息肉患者，其中797例仅接受息肉切除术和监测。监测内镜检查的中位时间为182天，平均为220.01天。这比推荐的临床指南365天要早得多。没有患者或手术特征能够预测结肠镜监测时间的差异。没有病理因素似乎会改变监测内镜检查的时间（P>0.05）。
总体而言，患者接受监测内镜检查的时间比指南建议的要早得多。然而，这些指南以及其他恶性息肉监测方法的依据并不充分。未来的技术发展，包括成像技术的改进，可能会为恶性息肉的监测提供更多选择。
