Scripties UMCG - Rijksuniversiteit Groningen
English | Nederlands

Increasing Number of Surgical Procedures Since the Colorectal Cancer Screening Program Does Not Lead to More Complications:A Single-Center Retrospective Cohort Study

(2018) Bosch, D.

Background Since the implementation of the Dutch colorectal cancer (CRC) screening program in 2014, the number of endoscopically detected colorectal polyps has increased substantially. In general, benign polyps are removed endoscopically; however in selected cases surgery is required. The aim of this study was to compare the clinical outcome and amount of surgical resections before and after implementation of the screening program.
Methods This retrospective cohort study included patients who underwent surgical removal of colorectal polyps between January 2012 and December 2017 in Isala, Zwolle, the Netherlands. Patients with preoperatively established malignancy, hereditary and familial colon tumors and those who underwent emergency surgery were excluded.
Results 164 patients were included. A segmental colectomy (major surgery) was performed in most cases (70.1%, n = 115); the remaining 49 patients (29.9%) underwent transanal endoscopic microsurgery or laparoscopic wedge resection (minor surgery). In the two years before implementation of the screening program, a total number of 18 patients in 2012 and 17 patients in 2013 with surgical resections were included. Since the implementation, this number increased every year to 36 patients in 2017. Prior to the implementation only major surgeries were performed, 41.2% of surgical procedures were minor surgeries afterwards (p < 0.001). The overall complication rate after minor surgery was 16.3%, compared to 44.3% after major surgery (p = 0.001). Major complications (Clavien-Dindo ≥ 3b) occurred in 8 patients (4.9%), of which 7 after major surgery, with no mortality.
Conclusion Since the implementation of the CRC screening program, the number of surgically resected colorectal polyps has doubled, with a shift towards minor surgery. Minor surgery is associated with a lower complication rate compared to major surgery.

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