Hallam Sally, Farrugia Alexia, Naumann David N, Trudgill Nigel, Rout Shantanu, Karandikar Sharad
University Hospitals Birmingham, Bordesley Green East, Birmingham, B9 5SS, UK.
Sandwell and West Birmingham NHS Trust, Hallam Street, West Bromwich, B71 4HJ, UK.
Int J Colorectal Dis. 2024 Dec 22;39(1):209. doi: 10.1007/s00384-024-04780-y.
Endoscopic resection is appropriate for selected colorectal polyp cancers, but significant variation exists in treatment. This study aims to investigate variation in management of screen-detected polyp cancers (T1), factors predicting primary endoscopic polypectomy and threshold for subsequent surgical resection.
Patients with polyp cancers (T1) diagnosed by the bowel cancer screening programme (BCSP) were investigated at two screening centres (5 individual sites and 4 MDTs, 2012-2022). Patient demographics, pathological characteristics, management and outcomes were recorded. Variation in management was compared between sites. Risk factors for primary endoscopic polypectomy and the need for subsequent surgical resection were analysed using multivariable binary logistic regression models.
Of 220 polyp cancers, 178 (81%) underwent primary endoscopic resection. Secondary surgical excision was required in 54 (30%). Study sites were not significantly different in their primary management for colonic or rectal polyps. Only the size of colonic polyps was associated with primary surgery rather than endoscopic polypectomy (OR 1.05 (95% CI 1.00-1.11); p = 0.038). There was a difference between study sites in the odds ratio for secondary surgery after primary polypectomy for colonic polyps (OR 3.97 (95% CI 1.20-16.0); p = 0.033) but not rectal. Other factors associated with the requirement for secondary surgery were as follows: sessile morphology for colonic polyps (OR 2.92 (95% CI 1.25-6.97); p = 0.013) and en-bloc resection for rectal polyps (OR 0.14 (0.02-0.85); p = 0.043).
There was significant variation in the assessment and treatment of colonic polyp cancers. Standardising pathology reporting and treatment algorithms may lead to better consistency of care and a reduction in secondary surgery.
内镜切除适用于部分结直肠息肉癌，但治疗方式存在显著差异。本研究旨在调查筛查发现的息肉癌（T1）的管理差异、预测初次内镜下息肉切除术的因素以及后续手术切除的阈值。
在两个筛查中心（5个独立站点和4个多学科团队，2012 - 2022年）对通过肠癌筛查计划（BCSP）诊断为息肉癌（T1）的患者进行调查。记录患者的人口统计学特征、病理特征、管理情况和结局。比较各站点之间管理的差异。使用多变量二元逻辑回归模型分析初次内镜下息肉切除术和后续手术切除需求的危险因素。
在220例息肉癌患者中，178例（81%）接受了初次内镜切除。54例（30%）需要二次手术切除。各研究站点对结肠或直肠息肉的初始管理无显著差异。仅结肠息肉的大小与初次手术而非内镜下息肉切除术相关（比值比1.05（95%置信区间1.00 - 1.11）；p = 0.038）。各研究站点在结肠息肉初次息肉切除术后二次手术的比值比存在差异（比值比3.97（95%置信区间1.20 - 16.0）；p = 0.033），但直肠息肉无差异。与二次手术需求相关的其他因素如下：结肠息肉的无蒂形态（比值比2.92（95%置信区间）1.25 - 6.97）；p = 0.013）和直肠息肉的整块切除（比值比0.14（0.02 - 0.85）；p = 0.043）。
结肠息肉癌的评估和治疗存在显著差异。规范病理报告和治疗算法可能会使护理的一致性更好，并减少二次手术。
