An evidence-based treatment algorithm for colorectal polyp cancers: results from the Scottish Screen-detected Polyp Cancer Study (SSPoCS)

Richards, Colin H.; Ventham, Nicholas T.; Mansouri, David; Wilson, M.G.F.; Ramsay, George; Mackay, Craig; Parnaby, Craig; Smith, Dudley; On, Jotaro; Speake, Doug; McFarlane, Gordon A.; Neo, Yan Ning; Aitken, Emma; Forrest, Cynthia H.; Knight, Kevin; McKay, Andrew; Nair, H; Mulholland, Clancy; Robertson, J. H.; Carey, Frank; Steele, Robert

doi:10.1136/gutjnl-2016-312201

Cited by 37 publications

(54 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A study of the Scottish Surgical Research Group on 485 patients with T1CRCs, which were identified through the screening program between 2000 and 2012, found no significant difference in adverse outcomes between pedunculated and nonpedunculated T1CRCs after adjustment for confounders. 34 However, this study only included patients who underwent endoscopic resection (followed by segmental resection or not), which may have led to exclusion of nonpedunculated high-risk T1CRCs unfit for endoscopic resection in particular, leading to an underestimation of adverse outcomes in the nonpedunculated T1CRC group.…”

Section: Discussionmentioning

confidence: 99%

Pedunculated Morphology of T1 Colorectal Tumors Associates With Reduced Risk of Adverse Outcome

Kessels

Backes

Elias

et al. 2019

Clinical Gastroenterology and Hepatology

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Pedunculated Morphology of T1 Colorectal Tumors Associates With Reduced Risk of Adverse Outcome

Kessels

Backes

Elias

et al. 2019

Clinical Gastroenterology and Hepatology

View full text Add to dashboard Cite

show abstract

“…However, evidence is now accumulating that such a clearance may not be necessary as long as the distance between the invasive front and resection margin can be assessed and accurately measured. For example, a national cohort study in Scotland reported that a “positive” polyp resection margin was only associated with residual disease in the bowel wall if tumor cells extended into the diathermy burn zone. Similarly, updated national guidelines in Japan now state that the vertical margin of an MCP should only be considered positive if carcinoma is exposed at the submucosal margin …”

Section: Introductionmentioning

confidence: 99%

Revising the definition of vertical margin involvement following endoscopic polypectomy may reduce unnecessary surgery in patients with malignant colorectal polyps

et al. 2019

View full text Add to dashboard Cite

Background and Study Aims Endoscopically resected malignant colorectal polyps (MCPs) present a dilemma regarding whether the risk of residual disease justifies a major bowel resection. Overtreatment is common, and the vast majority of patients who undergo resection have no residual tumor. The aim of this study was to investigate whether revising the definition of vertical margin involvement following MCP polypectomy could reduce unnecessary surgery. Patients and Methods This was a cohort study of consecutive patients with MCPs treated at a tertiary hospital between 2004 and 2018. Data on demographics, index colonoscopy, polyp pathology, and any subsequent surgical resection were analyzed. Polypectomy resection margins were reviewed and measured to the nearest decimal place. The ability of existing guidelines (requiring a margin clearance of ≥ 1 mm) to predict residual disease was compared to a revised version requiring a margin clearance of ≥ 0.1 mm. Results A total of 129 patients with an MCP were included. Of these 129 patients, 77 (60%) underwent surgical resection, of which 62 (81%) had no residual tumor. Existing guidelines, requiring a margin clearance of ≥ 1 mm, classified 28 patients as being at “low risk” for residual disease. Of these, four underwent surgery, but none had residual tumor (P = 0.031). Revised guidelines, requiring a margin clearance of ≥ 0.1 mm, classified 44 patients as “low risk.” Of these, in the 13 that had surgery, no residual tumor was found (P = 0.003). Conclusions Revising the definition of vertical margin involvement leads to more patients being correctly classified as being at low risk of residual disease. This has the potential to reduce unnecessary surgery in patients with MCPs.

show abstract

“…This 10% rate of "residual disease" postpolypectomy of pT1 cancer is broadly that to be anticipated. Richards and colleagues advise segmental resection in cases of incom-plete resection or evidence of lymphovascular invasion (16). The presence of tumor budding may in the future be an additional indicator of potential nodal involvement in these early cancers (17).…”

Section: Discussionmentioning

confidence: 99%

A National Bowel Cancer Screening Programme using FIT: Achievements and Challenges

O’Donoghue¹,

Sheahan²,

MacMathúna³

et al. 2019

Cancer Prevention Research

View full text Add to dashboard Cite

Colorectal cancer accounts for 11% of all cancerrelated deaths in Ireland. With the aim of diagnosing these cancers at an earlier stage, and detecting premalignant lesions, the National Screening Service (NSS) offered a fecal immunochemical test (FIT) to all individuals aged 60 to 69. All individuals in the age range were contacted by post and invited to participate in the programme. Those with a positive FIT result were offered a colonoscopy in an internationally accredited unit. From an eligible population of 488,628, 196,238 individuals participated giving an uptake of 40.2%. Commencing at a FIT threshold of 20 mg Hg/g feces, the positivity rate was 8.6%, which overwhelmed colonoscopy capacity and, thus, the threshold was increased to 45 mg, resulting in an overall 5% positivity rate. A total of 520 individuals had cancer detected (68.3% stage I or II), of which 104 were removed endoscopically (pT1s). Adenomas were present in 54.2% of all colonoscopies, 17.4% deemed high risk. Despite a lower uptake, males were twice as likely to have colorectal cancers as females and had a 59% increased rate of high-risk adenomas diagnosed. Challenges facing the programme include increasing participation, especially among males, and increasing colonoscopy capacity. The ability to alter the sensitivity of FIT to match colonoscopy capacity is a valuable option for such a programme as it ensures that the maximum public health benefit can be achieved within available resources.

show abstract

An evidence-based treatment algorithm for colorectal polyp cancers: results from the Scottish Screen-detected Polyp Cancer Study (SSPoCS)

Abstract: A policy of surveillance is adequate for the majority of patients with screen-detected colorectal polyp cancers. Consideration of segmental resection should be reserved for those with incomplete excision or evidence of lymphovascular invasion.

Cited by 37 publications

References 28 publications

Pedunculated Morphology of T1 Colorectal Tumors Associates With Reduced Risk of Adverse Outcome

Pedunculated Morphology of T1 Colorectal Tumors Associates With Reduced Risk of Adverse Outcome

Revising the definition of vertical margin involvement following endoscopic polypectomy may reduce unnecessary surgery in patients with malignant colorectal polyps

A National Bowel Cancer Screening Programme using FIT: Achievements and Challenges

Contact Info

Product

Resources

About