School of Medicine and Cardiff and Vale University Health Board, Cardiff University, Cardiff, UK.
Guy's and St. Thomas' NHS Foundation Trust, London, UK.
Int J Colorectal Dis. 2023 Feb 3;38(1):28. doi: 10.1007/s00384-022-04299-0.
Team management strategies for complex colorectal polyps are recommended by professional guidelines. Multi-disciplinary meetings are used across the UK with limited information regarding their impact. The aim of this multi-centre observational study was to assess procedures and outcomes of patients managed using these approaches.
This was a retrospective, observational study of patients managed by six UK sites. Information was collected regarding procedures and outcomes including length of stay, adverse events, readmissions and cancers.
Two thousand one hundred ninety-two complex polyps in 2109 patients were analysed with increasing referrals annually. Most presented symptomatically and the mean polyp size was 32.1 mm. Primary interventions included endoscopic therapy (75.6%), conservative management (8.3%), colonic resection (8.1%), trans-anal surgery (6.8%) or combined procedures (1.1%). The number of primary colonic resections decreased over the study period without a reciprocal increase in secondary procedures or recurrence. Secondary procedures were required in 7.8%. The median length of stay for endoscopic procedures was 0 days with 77.5% completed as day cases. Median length of stay was 5 days for colonic resections. Overall adverse event and 30-day readmission rates were 9.0% and 3.3% respectively. Malignancy was identified in 8.8%. Benign polyp recurrence occurred in 13.1% with a median follow up of 30.4 months. Screening detected lesions were more likely to undergo bowel resection. Colonic resection was associated with longer stays, higher adverse events and more cancers on final histology.
Multi-disciplinary team management of complex polyps is safe and effective. Standardisation of organisation and quality monitoring is needed to continue positive effects on outcomes and services.
专业指南推荐了用于复杂结直肠息肉的团队管理策略。英国各地都在使用多学科会议，但关于其影响的信息有限。本多中心观察性研究的目的是评估使用这些方法管理的患者的程序和结果。
这是一项对六个英国站点管理的患者进行回顾性、观察性研究。收集了有关程序和结果的信息，包括住院时间、不良事件、再入院和癌症。
2109 名患者中有 2192 个复杂息肉，每年的转诊量都在增加。大多数患者表现出症状，平均息肉大小为 32.1 毫米。主要干预措施包括内镜治疗（75.6%）、保守治疗（8.3%）、结肠切除术（8.1%）、经肛门手术（6.8%）或联合手术（1.1%）。在研究期间，主要结肠切除术的数量减少，而次要手术或复发的数量没有相应增加。需要进行二次手术的比例为 7.8%。内镜治疗的中位住院时间为 0 天，77.5%的患者可在当天出院。结肠切除术的中位住院时间为 5 天。总体不良事件和 30 天再入院率分别为 9.0%和 3.3%。发现恶性肿瘤 8.8%。良性息肉复发率为 13.1%，中位随访时间为 30.4 个月。筛查发现的病变更有可能进行肠道切除。结肠切除术与较长的住院时间、较高的不良事件发生率和最终组织学上更多的癌症相关。
复杂息肉的多学科团队管理是安全有效的。需要标准化组织和质量监测，以继续对结果和服务产生积极影响。
