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

Publication Date:
2018-01-10
Publisher:
BMJ Publishing Group
Print ISSN:
0017-5749
Electronic ISSN:
1468-3288
Topics:
Medicine
Published by:
http://www.bmj.com/
_version_ 1836398742601728000
autor Richards, C., Ventham, N., Mansouri, D., Wilson, M., Ramsay, G., Mackay, C., Parnaby, C., Smith, D., On, J., Speake, D., McFarlane, G., Neo, Y., Aitken, E., Forrest, C., Knight, K., McKay, A., Nair, H., Mulholland, C., Robertson, J., Carey, F., Steele, R., on behalf of The Scottish Surgical Research Group
beschreibung Objectives Colorectal polyp cancers present clinicians with a treatment dilemma. Decisions regarding whether to offer segmental resection or endoscopic surveillance are often taken without reference to good quality evidence. The aim of this study was to develop a treatment algorithm for patients with screen-detected polyp cancers. Design This national cohort study included all patients with a polyp cancer identified through the Scottish Bowel Screening Programme between 2000 and 2012. Multivariate regression analysis was used to assess the impact of clinical, endoscopic and pathological variables on the rate of adverse events (residual tumour in patients undergoing segmental resection or cancer-related death or disease recurrence in any patient). These data were used to develop a clinically relevant treatment algorithm. Results 485 patients with polyp cancers were included. 186/485 (38%) underwent segmental resection and residual tumour was identified in 41/186 (22%). The only factor associated with an increased risk of residual tumour in the bowel wall was incomplete excision of the original polyp (OR 5.61, p=0.001), while only lymphovascular invasion was associated with an increased risk of lymph node metastases (OR 5.95, p=0.002). When patients undergoing segmental resection or endoscopic surveillance were considered together, the risk of adverse events was significantly higher in patients with incomplete excision (OR 10.23, p〈0.001) or lymphovascular invasion (OR 2.65, p=0.023). Conclusion 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.
citation_standardnr 6134901
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insertion_date 2018-01-10
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shingle_author_1 Richards, C., Ventham, N., Mansouri, D., Wilson, M., Ramsay, G., Mackay, C., Parnaby, C., Smith, D., On, J., Speake, D., McFarlane, G., Neo, Y., Aitken, E., Forrest, C., Knight, K., McKay, A., Nair, H., Mulholland, C., Robertson, J., Carey, F., Steele, R., on behalf of The Scottish Surgical Research Group
shingle_author_2 Richards, C., Ventham, N., Mansouri, D., Wilson, M., Ramsay, G., Mackay, C., Parnaby, C., Smith, D., On, J., Speake, D., McFarlane, G., Neo, Y., Aitken, E., Forrest, C., Knight, K., McKay, A., Nair, H., Mulholland, C., Robertson, J., Carey, F., Steele, R., on behalf of The Scottish Surgical Research Group
shingle_author_3 Richards, C., Ventham, N., Mansouri, D., Wilson, M., Ramsay, G., Mackay, C., Parnaby, C., Smith, D., On, J., Speake, D., McFarlane, G., Neo, Y., Aitken, E., Forrest, C., Knight, K., McKay, A., Nair, H., Mulholland, C., Robertson, J., Carey, F., Steele, R., on behalf of The Scottish Surgical Research Group
shingle_author_4 Richards, C., Ventham, N., Mansouri, D., Wilson, M., Ramsay, G., Mackay, C., Parnaby, C., Smith, D., On, J., Speake, D., McFarlane, G., Neo, Y., Aitken, E., Forrest, C., Knight, K., McKay, A., Nair, H., Mulholland, C., Robertson, J., Carey, F., Steele, R., on behalf of The Scottish Surgical Research Group
shingle_catch_all_1 An evidence-based treatment algorithm for colorectal polyp cancers: results from the Scottish Screen-detected Polyp Cancer Study (SSPoCS)
Objectives Colorectal polyp cancers present clinicians with a treatment dilemma. Decisions regarding whether to offer segmental resection or endoscopic surveillance are often taken without reference to good quality evidence. The aim of this study was to develop a treatment algorithm for patients with screen-detected polyp cancers. Design This national cohort study included all patients with a polyp cancer identified through the Scottish Bowel Screening Programme between 2000 and 2012. Multivariate regression analysis was used to assess the impact of clinical, endoscopic and pathological variables on the rate of adverse events (residual tumour in patients undergoing segmental resection or cancer-related death or disease recurrence in any patient). These data were used to develop a clinically relevant treatment algorithm. Results 485 patients with polyp cancers were included. 186/485 (38%) underwent segmental resection and residual tumour was identified in 41/186 (22%). The only factor associated with an increased risk of residual tumour in the bowel wall was incomplete excision of the original polyp (OR 5.61, p=0.001), while only lymphovascular invasion was associated with an increased risk of lymph node metastases (OR 5.95, p=0.002). When patients undergoing segmental resection or endoscopic surveillance were considered together, the risk of adverse events was significantly higher in patients with incomplete excision (OR 10.23, p<0.001) or lymphovascular invasion (OR 2.65, p=0.023). Conclusion 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.
Richards, C., Ventham, N., Mansouri, D., Wilson, M., Ramsay, G., Mackay, C., Parnaby, C., Smith, D., On, J., Speake, D., McFarlane, G., Neo, Y., Aitken, E., Forrest, C., Knight, K., McKay, A., Nair, H., Mulholland, C., Robertson, J., Carey, F., Steele, R., on behalf of The Scottish Surgical Research Group
BMJ Publishing Group
0017-5749
00175749
1468-3288
14683288
shingle_catch_all_2 An evidence-based treatment algorithm for colorectal polyp cancers: results from the Scottish Screen-detected Polyp Cancer Study (SSPoCS)
Objectives Colorectal polyp cancers present clinicians with a treatment dilemma. Decisions regarding whether to offer segmental resection or endoscopic surveillance are often taken without reference to good quality evidence. The aim of this study was to develop a treatment algorithm for patients with screen-detected polyp cancers. Design This national cohort study included all patients with a polyp cancer identified through the Scottish Bowel Screening Programme between 2000 and 2012. Multivariate regression analysis was used to assess the impact of clinical, endoscopic and pathological variables on the rate of adverse events (residual tumour in patients undergoing segmental resection or cancer-related death or disease recurrence in any patient). These data were used to develop a clinically relevant treatment algorithm. Results 485 patients with polyp cancers were included. 186/485 (38%) underwent segmental resection and residual tumour was identified in 41/186 (22%). The only factor associated with an increased risk of residual tumour in the bowel wall was incomplete excision of the original polyp (OR 5.61, p=0.001), while only lymphovascular invasion was associated with an increased risk of lymph node metastases (OR 5.95, p=0.002). When patients undergoing segmental resection or endoscopic surveillance were considered together, the risk of adverse events was significantly higher in patients with incomplete excision (OR 10.23, p<0.001) or lymphovascular invasion (OR 2.65, p=0.023). Conclusion 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.
Richards, C., Ventham, N., Mansouri, D., Wilson, M., Ramsay, G., Mackay, C., Parnaby, C., Smith, D., On, J., Speake, D., McFarlane, G., Neo, Y., Aitken, E., Forrest, C., Knight, K., McKay, A., Nair, H., Mulholland, C., Robertson, J., Carey, F., Steele, R., on behalf of The Scottish Surgical Research Group
BMJ Publishing Group
0017-5749
00175749
1468-3288
14683288
shingle_catch_all_3 An evidence-based treatment algorithm for colorectal polyp cancers: results from the Scottish Screen-detected Polyp Cancer Study (SSPoCS)
Objectives Colorectal polyp cancers present clinicians with a treatment dilemma. Decisions regarding whether to offer segmental resection or endoscopic surveillance are often taken without reference to good quality evidence. The aim of this study was to develop a treatment algorithm for patients with screen-detected polyp cancers. Design This national cohort study included all patients with a polyp cancer identified through the Scottish Bowel Screening Programme between 2000 and 2012. Multivariate regression analysis was used to assess the impact of clinical, endoscopic and pathological variables on the rate of adverse events (residual tumour in patients undergoing segmental resection or cancer-related death or disease recurrence in any patient). These data were used to develop a clinically relevant treatment algorithm. Results 485 patients with polyp cancers were included. 186/485 (38%) underwent segmental resection and residual tumour was identified in 41/186 (22%). The only factor associated with an increased risk of residual tumour in the bowel wall was incomplete excision of the original polyp (OR 5.61, p=0.001), while only lymphovascular invasion was associated with an increased risk of lymph node metastases (OR 5.95, p=0.002). When patients undergoing segmental resection or endoscopic surveillance were considered together, the risk of adverse events was significantly higher in patients with incomplete excision (OR 10.23, p<0.001) or lymphovascular invasion (OR 2.65, p=0.023). Conclusion 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.
Richards, C., Ventham, N., Mansouri, D., Wilson, M., Ramsay, G., Mackay, C., Parnaby, C., Smith, D., On, J., Speake, D., McFarlane, G., Neo, Y., Aitken, E., Forrest, C., Knight, K., McKay, A., Nair, H., Mulholland, C., Robertson, J., Carey, F., Steele, R., on behalf of The Scottish Surgical Research Group
BMJ Publishing Group
0017-5749
00175749
1468-3288
14683288
shingle_catch_all_4 An evidence-based treatment algorithm for colorectal polyp cancers: results from the Scottish Screen-detected Polyp Cancer Study (SSPoCS)
Objectives Colorectal polyp cancers present clinicians with a treatment dilemma. Decisions regarding whether to offer segmental resection or endoscopic surveillance are often taken without reference to good quality evidence. The aim of this study was to develop a treatment algorithm for patients with screen-detected polyp cancers. Design This national cohort study included all patients with a polyp cancer identified through the Scottish Bowel Screening Programme between 2000 and 2012. Multivariate regression analysis was used to assess the impact of clinical, endoscopic and pathological variables on the rate of adverse events (residual tumour in patients undergoing segmental resection or cancer-related death or disease recurrence in any patient). These data were used to develop a clinically relevant treatment algorithm. Results 485 patients with polyp cancers were included. 186/485 (38%) underwent segmental resection and residual tumour was identified in 41/186 (22%). The only factor associated with an increased risk of residual tumour in the bowel wall was incomplete excision of the original polyp (OR 5.61, p=0.001), while only lymphovascular invasion was associated with an increased risk of lymph node metastases (OR 5.95, p=0.002). When patients undergoing segmental resection or endoscopic surveillance were considered together, the risk of adverse events was significantly higher in patients with incomplete excision (OR 10.23, p<0.001) or lymphovascular invasion (OR 2.65, p=0.023). Conclusion 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.
Richards, C., Ventham, N., Mansouri, D., Wilson, M., Ramsay, G., Mackay, C., Parnaby, C., Smith, D., On, J., Speake, D., McFarlane, G., Neo, Y., Aitken, E., Forrest, C., Knight, K., McKay, A., Nair, H., Mulholland, C., Robertson, J., Carey, F., Steele, R., on behalf of The Scottish Surgical Research Group
BMJ Publishing Group
0017-5749
00175749
1468-3288
14683288
shingle_title_1 An evidence-based treatment algorithm for colorectal polyp cancers: results from the Scottish Screen-detected Polyp Cancer Study (SSPoCS)
shingle_title_2 An evidence-based treatment algorithm for colorectal polyp cancers: results from the Scottish Screen-detected Polyp Cancer Study (SSPoCS)
shingle_title_3 An evidence-based treatment algorithm for colorectal polyp cancers: results from the Scottish Screen-detected Polyp Cancer Study (SSPoCS)
shingle_title_4 An evidence-based treatment algorithm for colorectal polyp cancers: results from the Scottish Screen-detected Polyp Cancer Study (SSPoCS)
timestamp 2025-06-30T23:31:55.419Z
titel An evidence-based treatment algorithm for colorectal polyp cancers: results from the Scottish Screen-detected Polyp Cancer Study (SSPoCS)
titel_suche An evidence-based treatment algorithm for colorectal polyp cancers: results from the Scottish Screen-detected Polyp Cancer Study (SSPoCS)
topic WW-YZ
uid ipn_articles_6134901