Cecily Stockley1, Bradley Evans2, Muna Lougheed2, Haley Flemming3, Altaf Taher4, Mark Borgaonkar5, David Pace2. 1. Department of Surgery, Memorial University of Newfoundland, St. John's, NL, Canada. ccs106@mun.ca. 2. Department of Surgery, Memorial University of Newfoundland, St. John's, NL, Canada. 3. Department of Family Medicine, Memorial University of Newfoundland, St. John's, NL, Canada. 4. Department of Pathology, Memorial University of Newfoundland, St. John's, NL, Canada. 5. Department of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada.
Abstract
PURPOSE: To examine local practice for non-malignant polyps and to calculate morbidity and mortality associated with bowel resection for this indication. METHODS: This retrospective cohort study was conducted by reviewing our local gastrointestinal pathology database over a five-year period to identify colonic resections performed for benign polyps. Using search terms "polyp" and "adenoma," 272 cases were identified. Exclusion criteria included: cancer diagnosis, emergency surgeries, multiple resections, and subtotal colectomies for polyposis. 106 patients were included in the study. Primary outcome was perioperative mortality. Secondary outcomes included patient morbidity, characteristics of polyps requiring surgery, and the number of patients referred for a second endoscopic opinion prior to proceeding with surgery. RESULTS: 64 male and 42 female patients with a mean age of 65.3 years (± 8.6 years) underwent colon resection for benign polyps. The mean polyp size was 32.7 mm (± 19.5 mm). 30 patients (28.6%) had polyps equal to or less than 2 cm. Most of the polyps described were sessile (n = 55, 51.9%) and located in the right colon (n = 84, 79.3%). Endoscopic resection was attempted in 31 patients (29.2%), and five cases (4.7%) were referred for a second endoscopic opinion prior to proceeding with surgery. Endoscopists incorrectly felt that polyps were malignant in 62 cases (58.5%). Using Clavien-Dindo classification, most patients had no complications n = 36 (34.0%) or minor complications n = 41 (38.7%). Twelve patients (11.3%) had complications that required antibiotics, blood transfusions, or total parental nutrition. Nine patients (8.5%) required surgical or endoscopic management. Six patients (5.7%) required ICU admission. Mortality rate was 1.9% (n = 2). CONCLUSION: Surgery for benign colonic polyps is associated with significant morbidity and mortality. These findings reveal a gap in endoscopic management of benign colonic polyps.
PURPOSE: To examine local practice for non-malignant polyps and to calculate morbidity and mortality associated with bowel resection for this indication. METHODS: This retrospective cohort study was conducted by reviewing our local gastrointestinal pathology database over a five-year period to identify colonic resections performed for benign polyps. Using search terms "polyp" and "adenoma," 272 cases were identified. Exclusion criteria included: cancer diagnosis, emergency surgeries, multiple resections, and subtotal colectomies for polyposis. 106 patients were included in the study. Primary outcome was perioperative mortality. Secondary outcomes included patient morbidity, characteristics of polyps requiring surgery, and the number of patients referred for a second endoscopic opinion prior to proceeding with surgery. RESULTS: 64 male and 42 female patients with a mean age of 65.3 years (± 8.6 years) underwent colon resection for benign polyps. The mean polyp size was 32.7 mm (± 19.5 mm). 30 patients (28.6%) had polyps equal to or less than 2 cm. Most of the polyps described were sessile (n = 55, 51.9%) and located in the right colon (n = 84, 79.3%). Endoscopic resection was attempted in 31 patients (29.2%), and five cases (4.7%) were referred for a second endoscopic opinion prior to proceeding with surgery. Endoscopists incorrectly felt that polyps were malignant in 62 cases (58.5%). Using Clavien-Dindo classification, most patients had no complications n = 36 (34.0%) or minor complications n = 41 (38.7%). Twelve patients (11.3%) had complications that required antibiotics, blood transfusions, or total parental nutrition. Nine patients (8.5%) required surgical or endoscopic management. Six patients (5.7%) required ICU admission. Mortality rate was 1.9% (n = 2). CONCLUSION: Surgery for benign colonic polyps is associated with significant morbidity and mortality. These findings reveal a gap in endoscopic management of benign colonic polyps.
Authors: Anne F Peery; Nicholas J Shaheen; Katherine S Cools; Todd H Baron; Mark Koruda; Joseph A Galanko; Ian S Grimm Journal: Gastrointest Endosc Date: 2017-04-10 Impact factor: 9.427
Authors: Yuri Hanada; Alyssa Y Choi; Joo Ha Hwang; Peter V Draganov; Lauren Khanna; Amrita Sethi; Michael J Bartel; Neha Goel; Seiichiro Abe; Rabia A De Latour; Kenneth Park; Marcovalerio Melis; Elliot Newman; Ioannis Hatzaras; Sanjay S Reddy; Jeffrey M Farma; Xiuli Liu; Alexander Schlachterman; Jesse Kresak; Garrick Trapp; Nadia Ansari; Beth Schrope; Jong Yeul Lee; Deepti Dhall; Simon Lo; Laith H Jamil; Miguel Burch; Srinivas Gaddam; Yulan Gong; Armando Del Portillo; Yutaka Tomizawa; Camtu D Truong; Olaya I Brewer Gutierrez; Elizabeth Montgomery; Fabian M Johnston; Mark Duncan; Marcia Canto; Nita Ahuja; Anne Marie Lennon; Saowanee Ngamruengphong Journal: Clin Gastroenterol Hepatol Date: 2018-11-22 Impact factor: 11.382
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