PMID- 29999580
OWN - NLM
STAT- MEDLINE
DCOM- 20191125
LR  - 20191125
IS  - 1463-1318 (Electronic)
IS  - 1462-8910 (Linking)
VI  - 20
IP  - 12
DP  - 2018 Dec
TI  - Variations in the management of significant polyps and early colorectal cancer: 
      results from a multicentre observational study of 383 patients.
PG  - 1088-1096
LID - 10.1111/codi.14342 [doi]
AB  - AIM: The concept of significant polyps and early colorectal cancer (SPECC) 
      encompasses complex polyps not amenable to routine snare polypectomy or where 
      malignancy cannot be excluded. Surgical resection (SR) offers definitive 
      treatment, but is overtreatment for the majority which are benign and amenable to 
      less invasive endoscopic resection (ER). The aim of this study was to investigate 
      variations in the management and outcomes of significant colorectal polyps. 
      METHOD: This was a retrospective observational study of significant colorectal 
      polyps, defined as nonpedunculated lesions of >/= 20 mm size, diagnosed across nine 
      UK hospitals in 2014. Inclusion criteria were endoscopically or histologically 
      benign polyps at biopsy. RESULTS: A total of 383 patients were treated by primary 
      ER (87.2%) or SR (12.8%). Overall, 108/383 (28%) polyps were detected in the 
      Bowel Cancer Screening Programme (BCSP). Primary SR was associated with a 
      significantly longer length of stay and major complications (P < 0.01). Of the ER 
      polyps, 290/334 (86.8%) patients were treated without undergoing surgery. The 
      commonest indication for secondary surgery was unexpected polyp cancer, and of 
      these cases 60% had no residual cancer in the specimen. Incidence of unexpected 
      cancer was 10.7% (n = 41) and was similar between ER and SR groups (P = 0.11). On 
      multivariate analysis, a polyp size of > 30 mm and non-BCSP status were 
      independent risk factors for primary SR [OR 2.51 (95% CI 1.08-5.82), P = 0.03]. 
      CONCLUSION: ER is safe and feasible for treating significant colorectal polyps. 
      Robust accreditation within the BCSP has led to improvements in management, with 
      lower rates of SR compared with non-BCSP patients. Standardization, training in 
      polyp assessment and treatment within a multidisciplinary team may help to select 
      appropriate treatment strategies and improve outcomes.
CI  - Colorectal Disease (c) 2018 The Association of Coloproctology of Great Britain and 
      Ireland.
FAU - Dattani, M
AU  - Dattani M
AD  - Pelican Cancer Foundation, Basingstoke, UK.
FAU - Crane, S
AU  - Crane S
AD  - Pelican Cancer Foundation, Basingstoke, UK.
FAU - Battersby, N J
AU  - Battersby NJ
AD  - Basingstoke and North Hampshire Hospital, Basingstoke, UK.
FAU - Di Fabio, F
AU  - Di Fabio F
AD  - Basingstoke and North Hampshire Hospital, Basingstoke, UK.
FAU - Saunders, B P
AU  - Saunders BP
AD  - St Mark's Hospital and Academic Institute, London, UK.
FAU - Dolwani, S
AU  - Dolwani S
AD  - School of Medicine, Cardiff University, Cardiff, UK.
FAU - Rutter, M D
AU  - Rutter MD
AD  - Department of Gastroenterology, University Hospital of North Tees, 
      Stockton-on-Tees, UK.
FAU - Moran, B J
AU  - Moran BJ
AD  - Basingstoke and North Hampshire Hospital, Basingstoke, UK.
CN  - SPECC study group
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Observational Study
DEP - 20180806
PL  - England
TA  - Colorectal Dis
JT  - Colorectal disease : the official journal of the Association of Coloproctology of 
      Great Britain and Ireland
JID - 100883611
SB  - IM
MH  - Aged
MH  - Colonic Polyps/complications/*surgery
MH  - Colonoscopy/*methods
MH  - Colorectal Neoplasms/diagnosis/etiology/*prevention & control
MH  - Early Detection of Cancer/*methods
MH  - Feasibility Studies
MH  - Female
MH  - Humans
MH  - Length of Stay
MH  - Male
MH  - Medical Overuse/prevention & control
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Risk Factors
MH  - United Kingdom
OTO - NOTNLM
OT  - Bowel Cancer Screening Programme
OT  - Colorectal polyps
OT  - early colorectal cancer
OT  - endoscopic polypectomy
FIR - Suggett, Nigel
IR  - Suggett N
FIR - Goussous, Ghaleb
IR  - Goussous G
FIR - Edwards, David
IR  - Edwards D
FIR - Tayyab, Muhammad
IR  - Tayyab M
FIR - McKaig, Brian
IR  - McKaig B
FIR - Subramanian, Thejasvi
IR  - Subramanian T
FIR - Karandikar, Sharad
IR  - Karandikar S
FIR - Wild, John Benjamin
IR  - Wild JB
FIR - Osborne, Martin
IR  - Osborne M
FIR - Ward, Stephen
IR  - Ward S
FIR - McCullough, Peter
IR  - McCullough P
FIR - Soliman, Faris
IR  - Soliman F
FIR - Cunningham, Andrew
IR  - Cunningham A
FIR - Maw, Andrew
IR  - Maw A
FIR - Murphy, Frank
IR  - Murphy F
EDAT- 2018/07/13 06:00
MHDA- 2019/11/26 06:00
CRDT- 2018/07/13 06:00
PHST- 2018/04/30 00:00 [received]
PHST- 2018/07/11 00:00 [accepted]
PHST- 2018/07/13 06:00 [pubmed]
PHST- 2019/11/26 06:00 [medline]
PHST- 2018/07/13 06:00 [entrez]
AID - 10.1111/codi.14342 [doi]
PST - ppublish
SO  - Colorectal Dis. 2018 Dec;20(12):1088-1096. doi: 10.1111/codi.14342. Epub 2018 Aug 
      6.