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CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(05): E706-E712
DOI: 10.1055/a-1380-3017
Original article

Overutilization of surgical resection for benign colorectal polyps: analysis from a tertiary care center

Rayan Saade
1   Pathology and Laboratory Medicine, Albany Medical Center, Albany, New York, United States
,
Tyler Tsang
2   Albany Medical College, Albany, New York, United States
,
Michel Kmeid
1   Pathology and Laboratory Medicine, Albany Medical Center, Albany, New York, United States
,
David Miller
2   Albany Medical College, Albany, New York, United States
,
Zhiyan Fu
1   Pathology and Laboratory Medicine, Albany Medical Center, Albany, New York, United States
,
James Litynski
3   Gastroenterology, Albany Medical Center, Albany, New York, United States
,
Patrick Young
4   Gastroenterology Service, Department of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, United States
,
Joseph C. Anderson
5   Department of Veterans Affairs Medical Center, White River Junction, Vermont, United States, and The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States
6   Division of Gastroenterology and Hepatology University of Connecticut School of Medicine, Farmington, Connecticut, United States
,
Hwajeong Lee
1   Pathology and Laboratory Medicine, Albany Medical Center, Albany, New York, United States
,
Micheal Tadros
3   Gastroenterology, Albany Medical Center, Albany, New York, United States
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Abstract

Background and study aims Adequate removal of precancerous polyps is an independent factor in colorectal cancer prevention. Despite advances in polypectomy techniques, there is an increasing rate of surgery for benign polyps. We assessed whether surgical resection is properly utilized for benign colorectal polyps.

Patients and methods We identified 144 patients with surgical resection for benign colorectal polyps. Polyp location, size and the indication for and type of surgery were obtained. For the purposes of this analysis, we assumed that gastroenterologists should assess polyp size accurately, endoscopically resect polyps < 2 cm, and treat incompletely excised polyps on follow-up.

Results A total of 118 patients (82 %) were referred to surgery without attempted endoscopic removal. In 26 (22 %) of 118, the macroscopic polyp size was < 2 cm (23 in right, 3 in the left colon) and 18 (15 %; 14 in the right, four in the left colon) were found to have had size overestimation during endoscopy. Twenty-two (15 %) of 144 underwent surgical resection for incomplete endoscopic resection of adenomas (16 in the right, 6 in the left colon); 12 (54.5 %) had a residual polyp size of < 2 cm (10 in the right colon; 2 in the left colon). In-hospital mortality was 0.7 % and morbidity was 20.1 %.

Conclusions Of the patients, 41 % could have potentially avoided surgical intervention (37 polyps < 2 cm and/or size overestimations precluding endoscopic polypectomy and 22 incomplete resections). When including polyps with size ≥ 2 to < 4 cm, the percentage of patients with avoidable surgery reached 80 %. This confirms the need to develop standardized quality metrics for endoscopic polypectomies and for better overall training of endoscopists performing these procedures. Given the risks of surgery, referral to an experienced gastroenterologist should be considered as a first step.

Supplementary material



Publication History

Received: 02 August 2020

Accepted: 28 December 2020

Article published online:
22 April 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

Refers to:

Overutilization of surgery for the resection of benign colorectal lesions: the hidden reasons for inappropriate referral!Endosc Int Open 2021; 09(05): E713-E715
DOI: 10.1055/a-1373-5176

Comment to this article:

Endoscopy International Open – recently publishedEndoscopy 2021; 53(06): 669-669
DOI: 10.1055/a-1406-1208

 

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