The impact of the national bowel screening program in the Netherlands on detection and treatment of endoscopically unresectable benign polyps

Abstract

BackgroundIn January 2014, a national bowel cancer screening program started in the Netherlands. The program is being implemented in phases until 2019. Due to this program, an increase in patients referred for a colorectal resection for benign, but endoscopically unresectable polyps, is expected. So far, most resections are performed according to oncological principles despite no pre-operative histological diagnosis of malignancy. The aim of this study was to analyze the increase in referred patients during the first year of the screening program and to compare pathological results and clinical outcome of resections of patients undergoing resection for benign polyps before and after implementation of screening.MethodsPatients referred for colorectal resection without biopsy-proven cancer between January 2009 and January December 2014 were identified from a prospectively maintained database. Patients with endoscopically macroscopic features of carcinoma were excluded.ResultsSeventy-six patients were included. Forty-seven patients (61.8%) were operated on in the 5 years prior to implementation of the screening program, and 29 patients (38.2%) were operated during the first year of implementation of the screening program. The overall malignancy rate before the introduction of the program was 14.1 and 6.6% after it had started (p = .469). All resections were performed laparoscopically; the conversion rate was 3.9% (n = 3). The overall mortality rate was 2.7% (n = 2), major complications (Clavien–Dindo > 3b) occurred in 11.8% (n = 9) of patients. The anastomotic leakage rate was 3.9% (n = 3).ConclusionsThe number of patients referred for benign polyps tripled after introduction of the screening program. With an overall major morbidity and mortality rate of 11.8%, it seems valid to discuss whether an endoscopic excision with advanced techniques with or without laparoscopic assistance would be preferable in this patient group, accepting a 6.6% reoperation rate for additional oncological resection with lymph node sampling in patients in whom a malignancy is found on histological analysis of the complete polyp.

International evaluation of circumferential resection margins after rectal cancer resection: insights from the Swedish and Dutch audits

“…In the international literature, a wide range of categories are used for rectal cancer volume at hospital level. Van Gijn et al calculated median cut-off points from published rectal cancer hospital volume studies, leading to a definition of a high-volume hospital a performing more than 24 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) rectal cancer resections per year and low-volume hospitals performing 9 (6-14) [28]. This hampers interpretation of the available literature on this topic.…”

Combined endo-laparoscopic surgery for difficult benign colorectal polyps

“…It was reported that the incidence of CRC significantly decreased by 76-90% with endoscopic removal of colorectal adenomatous polyps (4). In recent years, there was implementation of national colorectal cancer screening program in many countries and increasing detection of premalignant or early malignant colorectal polyps was observed (5). Most of the polyps can be removed by conventional endoscopic procedures, including cold/hot biopsy, snare polypectomy or endoscopic mucosal resection (EMR).…”

Significant polyp and early colorectal cancer – decision‐making and treatment planning in regional networks and multidisciplinary teams

“…This approach is necessary rather than merely considered desirable in an era of increased detection of SPECC lesions as a consequence of colorectal cancer screening . It is also imperative that advances in diagnostic and therapeutic technology in endoscopy require integration with clinically effective and cost‐effective healthcare processes in order to achieve the optimal individualized patient outcomes.…”

“…We suggest that this systematic approach should be considered as the standard of care rather than attempting often inappropriate therapy at the time of detection of the lesion without specific assessment or discussion with the patient regarding the appropriateness of treatment in their individual context and alternative treatment options that may be available and appropriate in a wider regional context. This approach is necessary rather than merely considered desirable in an era of increased detection of SPECC lesions as a consequence of colorectal cancer screening [10]. It is also imperative that advances in diagnostic and therapeutic technology in endoscopy require integration with clinically effective and costeffective healthcare processes in order to achieve the optimal individualized patient outcomes.…”