Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA, United States of America.
Department of Surgery, University of Colorado, Aurora, CO, United States of America.
PLoS One. 2023 Oct 25;18(10):e0293389. doi: 10.1371/journal.pone.0293389. eCollection 2023.
Despite advances in endoscopic techniques for management of benign colonic neoplasms, a rise in rates of surgical treatment has been reported. We used a nationally representative cohort to characterize temporal trends, patient characteristics, and outcomes associated with colectomy for colonic neoplasms.
All patients undergoing elective partial colectomy for benign or malignant colonic neoplasms were identified using the 2012-2019 National Inpatient Sample. Those presenting with inflammatory bowel disease, or experiencing intestinal perforation were excluded. Patients with benign neoplasms were classified as the Benign cohort (others: Malignant). Trends, characteristics, and outcomes were assessed between groups.
Of 569,280 colectomy procedures included for analysis, 153,435 (27.0%) were performed for benign lesions. The proportion of Benign operations decreased from 28.6% in 2012 to 23.7% in 2019 (P for trend<0.001). While overall national incidence of colectomy for benign neoplasms decreased from 2012 to 2019 (IRD -1.19, 95%CI -1.20- -1.19), Black patients demonstrated an incremental increase (IRD +0.04, 95%CI +0.02-0.06). On average, Benign was younger (66 [57-72] vs 68 years [58-77], P<0.001), and demonstrated a lower Elixhauser comorbidity index (2 [1-3] vs 3 [2-4], P<0.001), relative to Malignancy. Following adjustment, Benign demonstrated lower odds of in-hospital mortality (AOR 0.61, 95%CI 0.50-0.74; P<0.001), stoma creation (AOR 0.46, 95%CI 0.43-0.50; P<0.001), and infectious complications (AOR 0.68, 95%CI 0.63-0.73; P<0.001).
The present national study identifies a decrease in colectomy for benign polyps from 2012-2019. Future investigations should identify patients who would most benefit from surgical resection and address persistent inequities in access to screening and treatment for colonic neoplasms.
尽管内镜技术在良性结肠肿瘤的治疗方面取得了进步，但据报道手术治疗的比例有所上升。我们使用全国代表性队列来描述与结肠肿瘤切除术相关的时间趋势、患者特征和结局。
使用 2012 年至 2019 年全国住院患者样本，确定所有接受择期部分结肠切除术治疗良性或恶性结肠肿瘤的患者。排除患有炎症性肠病或发生肠穿孔的患者。良性肿瘤患者被分为良性肿瘤组（其他：恶性肿瘤）。评估组间的趋势、特征和结局。
在纳入分析的 569280 例结肠切除术患者中，153435 例（27.0%）为良性病变。良性手术的比例从 2012 年的 28.6%下降到 2019 年的 23.7%（趋势 P<0.001）。虽然全国范围内因良性肿瘤而行结肠切除术的总体发病率从 2012 年到 2019 年有所下降（发病率下降率 -1.19，95%CI-1.20- -1.19），但黑人患者的发病率呈递增趋势（发病率增加率 +0.04，95%CI+0.02-0.06）。平均而言，良性肿瘤患者年龄更小（66[57-72]岁 vs 68 岁[58-77]，P<0.001），Elixhauser 合并症指数更低（2[1-3] vs 3[2-4]，P<0.001），相对于恶性肿瘤。调整后，良性肿瘤患者院内死亡率（优势比 0.61，95%CI 0.50-0.74；P<0.001）、造口术（优势比 0.46，95%CI 0.43-0.50；P<0.001）和感染性并发症（优势比 0.68，95%CI 0.63-0.73；P<0.001）的几率较低。
本项全国性研究发现，2012 年至 2019 年，因良性息肉而行结肠切除术的比例有所下降。未来的研究应确定哪些患者最受益于手术切除，并解决结肠肿瘤筛查和治疗方面持续存在的不平等问题。
