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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.





ID 3870
Moeder ID 3802
Volgorde Bosch, D.
Naam BoschD
Publiceren yes
OAI-naam Student_thesis
Path root/geneeskunde/2018/BoschD/
Gemaakt op: 2019-01-14 15:24:38
Gemodificeerd op: 2019-01-14 15:24:38
Digitaal ID 5c3ca9b865608
Afstudeerrichting opleiding/afstudeerrichting 1
Studierichting Studierichting 1
Titel Increasing Number of Surgical Procedures Since the Colorectal Cancer Screening Program Does Not Lead to More Complications:A Single-Center Retrospective Cohort Study
Ruilverkeer mogelijk no
Printen in opdracht no
Aantal pagina's 24
Publicatiejaar 2018
Taal en
Engelse samenvatting 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.
Nederlandse samenvatting Achtergrond Sinds de introductie van het Nederlandse bevolkingsonderzoek (BVO) darmkanker in 2014 is het aantal endoscopisch gedetecteerde colorectale poliepen substantieel toegenomen. Benigne poliepen worden doorgaans endoscopisch verwijderd, maar soms is chirurgie vereist. Het doel van deze studie was de complicaties en het aantal chirurgische resecties voor en na de implementatie van het BVO te vergelijken.
Methoden Deze retrospectieve cohort studie includeerde patiënten die tussen januari 2012 en december 2017 een chirurgische resectie van colorectale poliepen hebben ondergaan in Isala, Zwolle, Nederland. Patiënten met preoperatief vastgestelde maligniteit, erfelijke en familiaire colontumoren en spoedoperaties werden geëxcludeerd.
Resultaten 164 patiënten werden geïncludeerd. De meeste patiënten (70.1%, n = 115) ondergingen een segmentale colectomie (uitgebreide chirurgie); de overige 49 patiënten (29.9%) ondergingen transanale endoscopische microchirurgie of een laparoscopische wigresectie (beperkte chirurgie). In de twee jaar voorafgaand aan de implementatie van het BVO werden in totaal 18 patiënten in 2012 en 17 patiënten in 2013 met chirurgische resecties geïncludeerd. Dit aantal nam na de implementatie elk jaar toe tot 36 patiënten in 2017. Hoewel voorafgaand aan implementatie alleen uitgebreide chirurgie werd uitgevoerd, was nadien 41.2% van de ingrepen beperkte chirurgie (p < 0.001). Het algehele complicatie percentage na beperkte chirurgie was 16.3%, vergeleken met 44.3% na uitgebreide ingrepen (p = 0,001). Ernstige complicaties (Clavien-Dindo ≥ 3b) kwamen voor bij 8 patiënten (4.9%), waarvan 7 na uitgebreide chirurgie, zonder mortaliteit.
Conclusie Sinds de implementatie van het BVO darmkanker is het aantal chirurgisch geresecteerde colorectale poliepen verdubbeld, met een verschuiving naar kleine ingrepen. Beperkte chirurgie is geassocieerd met een lager complicatie percentage vergeleken met uitgebreide chirurgie.
Onderwijsinstelling Medical Sciences
Type embargo abstract openbaar, scriptie op aanvraag
Auteur(s) Bosch, D.
Begeleider(s) opleidingsinstelling Supervisor,; Westreenen, H.L. van M.D., Ph.D.; Department of Surgery, Isala, Zwolle, the Netherlands
Auteur(s) Bosch, D.


 
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