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 21 June 2018

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News

Treatment algorithm for screen-detected colorectal polyp cancers

A study published in the current issue of Gut developed an evidence-based treatment algorithm for colorectal polyp cancers.

News image

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.

Dr Richards and colleagues from the United Kingdom developed a treatment algorithm for patients with screen-detected polyp cancers.

This national cohort study included all patients with a polyp cancer identified through the Scottish Bowel Screening Programme between 2000 and 2012.

The team assessed the impact of clinical, endoscopic and pathological variables on the rate of adverse events.

These data were used to develop a clinically relevant treatment algorithm.

The team included 485 patients with polyp cancers.

The researchers found that 186 out of 485 patients underwent segmental resection, and residual tumor was identified in 41 out of 186 patients.

The researchers found the only factor associated with an increased risk of residual tumor in the bowel wall was incomplete excision of the original polyp, while only lymphovascular invasion was associated with an increased risk of lymph node metastases.


The only factor associated with an increased risk of residual tumor was incomplete excision of the original polyp

Gut


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 lymphovascular invasion.

Dr Richards's team concluded, "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."

Gut 2018;67:299-306
20 February 2018

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