Laurien J van Nimwegen1, Leon M G Moons2, Joost M J Geesing3, L René Arensman4, Miangela Laclé5, Ivo A M J Broeders6, Peter P Viergever7, John N Groen8, Koen Kessels9, Matthijs P Schwartz1. 1. Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, Netherlands. 2. Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, Netherlands. 3. Department of Gastroenterology and Hepatology, Diakonessenhuis, Utrecht, Netherlands. 4. Department of Pathology, Meander Medical Center, Amersfoort, Netherlands. 5. Department of Pathology, University Medical Center, Utrecht, Netherlands. 6. Department of Surgery, Meander Medical Center, Amersfoort, Netherlands. 7. Department of Gastroenterology and Hepatology, Noordwest Ziekenhuisgroep, Alkmaar, Netherlands. 8. Department of Gastroenterology and Hepatology, St. Jansdal Hospital, Harderwijk, Netherlands. 9. Department of Gastroenterology and Hepatology, Flevo Hospital, Almere, Netherlands.
Abstract
BACKGROUND AND AIMS: Minimally invasive techniques are available to safely and efficaciously remove even the largest rectal polyps. This study aimed to investigate the magnitude of cases still referred for radical rectal surgery and the reasons for these referrals and to perform a re-evaluation of cases potentially suitable for endoscopic therapy. METHODS: A retrospective analysis of data from the Dutch Pathology Registry (Pathologic Anatomic Nationwide Automated Archive) was performed using the records of patients who underwent major surgical treatment for a histologically proven benign rectal polyp between 2005 and 2014 in the Netherlands. In a representative subset of 7 hospitals, detailed analysis was performed. An expert panel of 3 endoscopists reassessed all patient data to judge whether endoscopic treatment would have been a reasonable alternative. RESULTS: In the last decade 575 patients, and 56 patients in the subset of hospitals, were referred for major rectal surgery for a benign rectal polyp in the Netherlands. The number of radical resections declined over the years but stabilized in the last years. The main reasons for surgery were polyp size (34%), suspicion of malignancy (34%), and transanal endoscopic microsurgery failures (20%). In community hospitals, referrals for surgery were relatively more prevalent compared with academic hospitals (P < .01). Thirty-nine percent of patients had perioperative adverse events, and 1 patient (1.8%) died. Seventy-three percent of cases were assessed as "probably feasible" for endoscopic therapy. CONCLUSIONS: Over the last 10 years the rate of radical rectal surgery for a benign polyp declined. However, a significant subgroup of patients was still referred for invasive surgery at the cost of high morbidity and mortality. Referral to an expert endoscopist may avoid unnecessary surgery in most cases.
BACKGROUND AND AIMS: Minimally invasive techniques are available to safely and efficaciously remove even the largest rectal polyps. This study aimed to investigate the magnitude of cases still referred for radical rectal surgery and the reasons for these referrals and to perform a re-evaluation of cases potentially suitable for endoscopic therapy. METHODS: A retrospective analysis of data from the Dutch Pathology Registry (Pathologic Anatomic Nationwide Automated Archive) was performed using the records of patients who underwent major surgical treatment for a histologically proven benign rectal polyp between 2005 and 2014 in the Netherlands. In a representative subset of 7 hospitals, detailed analysis was performed. An expert panel of 3 endoscopists reassessed all patient data to judge whether endoscopic treatment would have been a reasonable alternative. RESULTS: In the last decade 575 patients, and 56 patients in the subset of hospitals, were referred for major rectal surgery for a benign rectal polyp in the Netherlands. The number of radical resections declined over the years but stabilized in the last years. The main reasons for surgery were polyp size (34%), suspicion of malignancy (34%), and transanal endoscopic microsurgery failures (20%). In community hospitals, referrals for surgery were relatively more prevalent compared with academic hospitals (P < .01). Thirty-nine percent of patients had perioperative adverse events, and 1 patient (1.8%) died. Seventy-three percent of cases were assessed as "probably feasible" for endoscopic therapy. CONCLUSIONS: Over the last 10 years the rate of radical rectal surgery for a benign polyp declined. However, a significant subgroup of patients was still referred for invasive surgery at the cost of high morbidity and mortality. Referral to an expert endoscopist may avoid unnecessary surgery in most cases.
Authors: N C A Vermeer; M P M de Neree Tot Babberich; P Fockens; I D Nagtegaal; C J H van de Velde; E Dekker; P J Tanis; K C M J Peeters Journal: BJS Open Date: 2019-07-30
Authors: Jasper L A Vleugels; Lianne Koens; Marcel G W Dijkgraaf; Britt Houwen; Yark Hazewinkel; Paul Fockens; Evelien Dekker Journal: Gut Date: 2019-12-10 Impact factor: 23.059
Authors: Gottumukkala Raju; Phillip Lum; William Ross; Selvi Thirumurthi; Ethan Miller; Patrick Lynch; Jeffrey Lee; Manoop S Bhutani; Mehnaz A Shafi; Brian Weston; Boris Blechacz; George J Chang; Katherine Hagan; Asif Rashid; Marta Davila; John Stroehlein Journal: Endosc Int Open Date: 2019-02-28
Authors: Thomas Worland; Oliver Cronin; Benjamin Harrison; Linda Alexander; Nik Ding; Alvin Ting; Stephanie Dimopoulos; Racheal Sykes; Sina Alexander Journal: Endosc Int Open Date: 2019-10-22