Colorectal Dis. 2022 Sep 11. doi: 10.1111/codi.16328. Online ahead of print.
ABSTRACT
The management of malignant polyps is a treatment dilemma in selecting between polypectomy and colorectal resection. To assist clinicians, guidelines have been developed by the Association of Coloproctology of Great Britain and Ireland (ACPGBI) to provide treatment recommendations.
METHODS: This study compared management strategy based on the ACPGBI risk categorisation for malignant polyps. Univariate and multivariable statistical analysis was undertaken to assess the factors predicting management strategy. A population wide analysis was performed of 1,646 malignant polyps, and the factors which predicted their management strategy, from Queensland, Australia from 2011-2019.
RESULTS: Overall 31.55% of patients with very-low or low risk disease proceeded to resection. Of those with high or very-high risk disease, 36.69% did not proceed to resection. In very-low and low risk polyps, age (p=0.003) and polyp location (p<0.001) were significantly different between the colorectal resection group and the polypectomy alone group. In those with very-high or high risk polyps age (p<0.001), type of facility (public or private) for the colonoscopy (p=0.037), right colonic polyps compared to left colonic (p=0.015) and rectal polyps (p<0.001) and mismatch repair mutations present (p=0.027) were predictive of resection in high risk disease using a multivariable model.
CONCLUSION: Over 30% of patients with very-low and low risk malignant polyps proceeded to resection, against the advice of guidelines. Furthermore, over 35% of patients with very-high or high risk malignant polyps did not proceed to resection. Education strategies may improve management decision choices. Furthermore, improvements in data collation will improve understanding management choices into the future.
PMID:36088629 | DOI:10.1111/codi.16328
