Aims
Non-malignant colorectal polyps (NMCP) are effectively managed by advanced endoscopic resection techniques, however rates of surgery remain high. We sought to understand the reasons for this.
Methods
A retrospective review was performed across our network to identify all elective surgery for NMCP between January 2011 and December 2024. Colectomy for polyposis syndromes were excluded. Electronic patient records were reviewed. Results were stratified as pre-2018 and post-2018, the latter reflecting a period where involvement of a tissue resection expert (TRE) for the management of large NMCP was recommended in major societal guidelines.
Results
116 elective resections for NMCP occurred (116/1951, 5.9% of colorectal neoplasia surgery). Mean age 67.3 years, 51% male. Mean ASA 2.46. 49.1% of surgery occurred in a tertiary facility (57/116). Mean length of stay was 9.12 days (Range 1.08 – 143 days, SD 14). 85.3% were laparoscopic. Major adverse events occurred in 30.2% of cases (35/116). Gastroenterologists accounted for 57.1% of referrals. 85% of cases had a preoperative biopsy. Lesion location was right colon 76.9%, left colon 13.8% and 10.3% rectum. Mean lesion size was 30.5mm (Range 1.5 – 85mm, SD 18.3). Suspected cancer was the most common indication for surgery (59/116, 50.9%), followed by appendix involvement (11/116, 9.5%) (Table 1). TRE were involved in just 20% of cases but more likely in a tertiary facility (p=0.049). After 2018 there was a significant decrease in surgery for NMCP across both tertiary and non-tertiary facilities (77/1039, 7.4% of colorectal neoplasia surgery pre-2018 and 39/912, 4.3% post-2018, p=0.0035). TRE involvement improved post-2018 (15.9% vs 27.8 p=0.008).
|
Reason for Surgery |
Pre 2018(%) |
Post 2018(%) |
|
Suspected Cancer |
36(46.8%) |
23(59%) |
|
Appendiceal |
4(5.2%) |
7(17.9%) |
|
Failed EMR – Technical reasons |
5(6.5%) |
1(2.6%) |
|
Failed EMR – ICV |
2(2.6%) |
2(5.1%) |
|
Failed EMR – Non Lifting |
3(3.9%) |
0 |
|
Size |
4(5.2%) |
1(2.6%) |
|
Recurrence |
4(5.2%) |
1(2.6%) |
|
Suspected Serrated Polyposis |
4(5.2%) |
1(2.6%) |
|
Suspected Polyposis |
3(3.9%) |
0 |
|
Involving ICV – Not attempted |
2(2.6%) |
1(2.6%) |
|
Patient Election |
0 |
1(2.6%) |
|
Suspected Fibrosis |
1(1.3%) |
0 |
|
Not Recorded |
9(11.7%) |
1(2.6%) |
|
Total |
77(100%) |
39(100%) |
Table 1. A comparison of the reasons given for surgery for non-malignant colorectal polyps pre-2018 and post-2018
Conclusions
Surgery rates for NMCPs have fallen. Despite this, unacceptable rates of surgery for NMCP continue to occur without adequate TRE involvement. All cases with benign histology on biopsy should be discussed with a TRE prior to surgery in a multidisciplinary team format.