Actual endoscopic versus predicted surgical mortality for treatment of advanced mucosal neoplasia of the colon
Background EMR of advanced mucosal neoplasia (AMN) (ie, sessile or laterally spreading lesions of ≥20 mm) of the colon has become an increasingly popular alternative to surgical resection. However, data regarding safety and mortality of EMR in comparison to surgery are limited. Objective To compare...
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| creator | Ahlenstiel, Golo, MBBS, MD Hourigan, Luke F., MBBS, FRACP Brown, Gregor, MBBS, FRACP, PhD Zanati, Simon, MBBS, FRACP Williams, Stephen J., MBBS, FRACP, MD Singh, Rajvinder, MBBS, FRACP, MRCP, FRCP Moss, Alan, MBBS, FRACP, MD Sonson, Rebecca, BNurs Bourke, Michael J., MBBS, FRACP |
| description | Background EMR of advanced mucosal neoplasia (AMN) (ie, sessile or laterally spreading lesions of ≥20 mm) of the colon has become an increasingly popular alternative to surgical resection. However, data regarding safety and mortality of EMR in comparison to surgery are limited. Objective To compare actual endoscopic with predicted surgical mortality. Design Prospective, observational, multicenter cohort study. Setting Academic, high-volume, tertiary-care referral center. Patients Consecutive patients referred for EMR. Intervention EMR. Main Outcome Measurements To predict hypothetical surgical mortality, the Association of Coloproctology of Great Britain and Ireland score, composed of physiological and surgical components, was calculated for each patient. Predicted surgical mortality was then compared with actual outcomes of EMR. The results were validated by an unselected subcohort by using the Colorectal Physiologic and Operative Severity Score for Enumeration of Mortality and Morbidity. Results Among 1050 patients with AMN treated by EMR, including patients with a predicted mortality rate of greater than 5% (13.8% of cohort), no deaths occurred within 30 days after the procedure. The predicted surgical mortality rate was 3.3% with the Association of Coloproctology of Great Britain and Ireland score ( P < .0001). This suggests a significant advantage of EMR over surgery. The results were validated by using the Colorectal Physiologic and Operative Severity Score for Enumeration of Mortality and Morbidity in 390 patients predicting a surgical mortality rate of 3.2% ( P = .0003). Limitations Nonrandomized study. Conclusion In this large multicenter study of EMR for colonic AMN, the predicted surgical mortality rate was significantly higher than the actual endoscopic mortality rate. Given that endoscopic therapy is less morbid and less expensive than surgery and can be performed as an outpatient treatment, it should be considered as the first line of treatment for most patients with these lesions. |
| doi_str_mv | 10.1016/j.gie.2014.04.015 |
| format | Article |
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However, data regarding safety and mortality of EMR in comparison to surgery are limited. Objective To compare actual endoscopic with predicted surgical mortality. Design Prospective, observational, multicenter cohort study. Setting Academic, high-volume, tertiary-care referral center. Patients Consecutive patients referred for EMR. Intervention EMR. Main Outcome Measurements To predict hypothetical surgical mortality, the Association of Coloproctology of Great Britain and Ireland score, composed of physiological and surgical components, was calculated for each patient. Predicted surgical mortality was then compared with actual outcomes of EMR. The results were validated by an unselected subcohort by using the Colorectal Physiologic and Operative Severity Score for Enumeration of Mortality and Morbidity. Results Among 1050 patients with AMN treated by EMR, including patients with a predicted mortality rate of greater than 5% (13.8% of cohort), no deaths occurred within 30 days after the procedure. The predicted surgical mortality rate was 3.3% with the Association of Coloproctology of Great Britain and Ireland score ( P < .0001). This suggests a significant advantage of EMR over surgery. The results were validated by using the Colorectal Physiologic and Operative Severity Score for Enumeration of Mortality and Morbidity in 390 patients predicting a surgical mortality rate of 3.2% ( P = .0003). Limitations Nonrandomized study. Conclusion In this large multicenter study of EMR for colonic AMN, the predicted surgical mortality rate was significantly higher than the actual endoscopic mortality rate. Given that endoscopic therapy is less morbid and less expensive than surgery and can be performed as an outpatient treatment, it should be considered as the first line of treatment for most patients with these lesions.</description><identifier>ISSN: 0016-5107</identifier><identifier>EISSN: 1097-6779</identifier><identifier>DOI: 10.1016/j.gie.2014.04.015</identifier><identifier>PMID: 24916925</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Australia ; Cause of Death ; Cohort Studies ; Colonic Neoplasms - mortality ; Colonic Neoplasms - pathology ; Colonic Neoplasms - surgery ; Colonoscopy - methods ; Colonoscopy - mortality ; Disease-Free Survival ; Education, Medical, Continuing ; Female ; Gastroenterology and Hepatology ; Humans ; Intestinal Mucosa - pathology ; Intestinal Mucosa - surgery ; Male ; Middle Aged ; Neoplasm Invasiveness - pathology ; Neoplasm Staging ; Predictive Value of Tests ; Prospective Studies ; Risk Assessment ; Survival Analysis</subject><ispartof>Gastrointestinal endoscopy, 2014-10, Vol.80 (4), p.668-676</ispartof><rights>American Society for Gastrointestinal Endoscopy</rights><rights>2014 American Society for Gastrointestinal Endoscopy</rights><rights>Copyright © 2014 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c478t-e91c8d2d71cdd12b0a88c44af1f39e988eb2a2a18dc98abb22c179b183675a7f3</citedby><cites>FETCH-LOGICAL-c478t-e91c8d2d71cdd12b0a88c44af1f39e988eb2a2a18dc98abb22c179b183675a7f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.gie.2014.04.015$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,45974</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24916925$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ahlenstiel, Golo, MBBS, MD</creatorcontrib><creatorcontrib>Hourigan, Luke F., MBBS, FRACP</creatorcontrib><creatorcontrib>Brown, Gregor, MBBS, FRACP, PhD</creatorcontrib><creatorcontrib>Zanati, Simon, MBBS, FRACP</creatorcontrib><creatorcontrib>Williams, Stephen J., MBBS, FRACP, MD</creatorcontrib><creatorcontrib>Singh, Rajvinder, MBBS, FRACP, MRCP, FRCP</creatorcontrib><creatorcontrib>Moss, Alan, MBBS, FRACP, MD</creatorcontrib><creatorcontrib>Sonson, Rebecca, BNurs</creatorcontrib><creatorcontrib>Bourke, Michael J., MBBS, FRACP</creatorcontrib><creatorcontrib>The Australian Colonic Endoscopic Mucosal Resection (ACE) Study Group</creatorcontrib><creatorcontrib>Australian Colonic Endoscopic Mucosal Resection (ACE) Study Group</creatorcontrib><title>Actual endoscopic versus predicted surgical mortality for treatment of advanced mucosal neoplasia of the colon</title><title>Gastrointestinal endoscopy</title><addtitle>Gastrointest Endosc</addtitle><description>Background EMR of advanced mucosal neoplasia (AMN) (ie, sessile or laterally spreading lesions of ≥20 mm) of the colon has become an increasingly popular alternative to surgical resection. However, data regarding safety and mortality of EMR in comparison to surgery are limited. Objective To compare actual endoscopic with predicted surgical mortality. Design Prospective, observational, multicenter cohort study. Setting Academic, high-volume, tertiary-care referral center. Patients Consecutive patients referred for EMR. Intervention EMR. Main Outcome Measurements To predict hypothetical surgical mortality, the Association of Coloproctology of Great Britain and Ireland score, composed of physiological and surgical components, was calculated for each patient. Predicted surgical mortality was then compared with actual outcomes of EMR. The results were validated by an unselected subcohort by using the Colorectal Physiologic and Operative Severity Score for Enumeration of Mortality and Morbidity. Results Among 1050 patients with AMN treated by EMR, including patients with a predicted mortality rate of greater than 5% (13.8% of cohort), no deaths occurred within 30 days after the procedure. The predicted surgical mortality rate was 3.3% with the Association of Coloproctology of Great Britain and Ireland score ( P < .0001). This suggests a significant advantage of EMR over surgery. The results were validated by using the Colorectal Physiologic and Operative Severity Score for Enumeration of Mortality and Morbidity in 390 patients predicting a surgical mortality rate of 3.2% ( P = .0003). Limitations Nonrandomized study. Conclusion In this large multicenter study of EMR for colonic AMN, the predicted surgical mortality rate was significantly higher than the actual endoscopic mortality rate. Given that endoscopic therapy is less morbid and less expensive than surgery and can be performed as an outpatient treatment, it should be considered as the first line of treatment for most patients with these lesions.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Australia</subject><subject>Cause of Death</subject><subject>Cohort Studies</subject><subject>Colonic Neoplasms - mortality</subject><subject>Colonic Neoplasms - pathology</subject><subject>Colonic Neoplasms - surgery</subject><subject>Colonoscopy - methods</subject><subject>Colonoscopy - mortality</subject><subject>Disease-Free Survival</subject><subject>Education, Medical, Continuing</subject><subject>Female</subject><subject>Gastroenterology and Hepatology</subject><subject>Humans</subject><subject>Intestinal Mucosa - pathology</subject><subject>Intestinal Mucosa - surgery</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoplasm Invasiveness - pathology</subject><subject>Neoplasm Staging</subject><subject>Predictive Value of Tests</subject><subject>Prospective Studies</subject><subject>Risk Assessment</subject><subject>Survival Analysis</subject><issn>0016-5107</issn><issn>1097-6779</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU2LFDEQhoMo7rj6A7xIH730mEp_JEEQlsUvWPCgnkO6Ur1m7O6MSXpg_r1pZvXgQSjIIc_7kjzF2Evge-DQvzns7z3tBYd2z8tA94jtgGtZ91Lqx2zHC1R3wOUVe5bSgXOuRANP2ZVoNfRadDu23GBe7VTR4kLCcPRYnSimNVXHSM5jJlelNd57LNAcYraTz-dqDLHKkWyeaclVGCvrTnbBAs8rhlTYhcJxssnb7Tb_oArDFJbn7Mlop0QvHs5r9v3D-2-3n-q7Lx8_397c1dhKlWvSgMoJJwGdAzFwqxS2rR1hbDRppWgQVlhQDrWywyAEgtQDqKaXnZVjc81eX3qPMfxaKWUz-4Q0Tba8a00Gul60Qva8LShcUIwhpUijOUY_23g2wM2m2RxM0Ww2zYaXga5kXj3Ur8NM7m_ij9cCvL0AVD558hRNQk-bIB8Js3HB_7f-3T9pnPyyreAnnSkdwhqXYs-AScJw83Xb87ZmaDk0HdfNb3_7pIY</recordid><startdate>20141001</startdate><enddate>20141001</enddate><creator>Ahlenstiel, Golo, MBBS, MD</creator><creator>Hourigan, Luke F., MBBS, FRACP</creator><creator>Brown, Gregor, MBBS, FRACP, PhD</creator><creator>Zanati, Simon, MBBS, FRACP</creator><creator>Williams, Stephen J., MBBS, FRACP, MD</creator><creator>Singh, Rajvinder, MBBS, FRACP, MRCP, FRCP</creator><creator>Moss, Alan, MBBS, FRACP, MD</creator><creator>Sonson, Rebecca, BNurs</creator><creator>Bourke, Michael J., MBBS, FRACP</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20141001</creationdate><title>Actual endoscopic versus predicted surgical mortality for treatment of advanced mucosal neoplasia of the colon</title><author>Ahlenstiel, Golo, MBBS, MD ; Hourigan, Luke F., MBBS, FRACP ; Brown, Gregor, MBBS, FRACP, PhD ; Zanati, Simon, MBBS, FRACP ; Williams, Stephen J., MBBS, FRACP, MD ; Singh, Rajvinder, MBBS, FRACP, MRCP, FRCP ; Moss, Alan, MBBS, FRACP, MD ; Sonson, Rebecca, BNurs ; Bourke, Michael J., MBBS, FRACP</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c478t-e91c8d2d71cdd12b0a88c44af1f39e988eb2a2a18dc98abb22c179b183675a7f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Australia</topic><topic>Cause of Death</topic><topic>Cohort Studies</topic><topic>Colonic Neoplasms - mortality</topic><topic>Colonic Neoplasms - pathology</topic><topic>Colonic Neoplasms - surgery</topic><topic>Colonoscopy - methods</topic><topic>Colonoscopy - mortality</topic><topic>Disease-Free Survival</topic><topic>Education, Medical, Continuing</topic><topic>Female</topic><topic>Gastroenterology and Hepatology</topic><topic>Humans</topic><topic>Intestinal Mucosa - pathology</topic><topic>Intestinal Mucosa - surgery</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neoplasm Invasiveness - pathology</topic><topic>Neoplasm Staging</topic><topic>Predictive Value of Tests</topic><topic>Prospective Studies</topic><topic>Risk Assessment</topic><topic>Survival Analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ahlenstiel, Golo, MBBS, MD</creatorcontrib><creatorcontrib>Hourigan, Luke F., MBBS, FRACP</creatorcontrib><creatorcontrib>Brown, Gregor, MBBS, FRACP, PhD</creatorcontrib><creatorcontrib>Zanati, Simon, MBBS, FRACP</creatorcontrib><creatorcontrib>Williams, Stephen J., MBBS, FRACP, MD</creatorcontrib><creatorcontrib>Singh, Rajvinder, MBBS, FRACP, MRCP, FRCP</creatorcontrib><creatorcontrib>Moss, Alan, MBBS, FRACP, MD</creatorcontrib><creatorcontrib>Sonson, Rebecca, BNurs</creatorcontrib><creatorcontrib>Bourke, Michael J., MBBS, FRACP</creatorcontrib><creatorcontrib>The Australian Colonic Endoscopic Mucosal Resection (ACE) Study Group</creatorcontrib><creatorcontrib>Australian Colonic Endoscopic Mucosal Resection (ACE) Study Group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Gastrointestinal endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ahlenstiel, Golo, MBBS, MD</au><au>Hourigan, Luke F., MBBS, FRACP</au><au>Brown, Gregor, MBBS, FRACP, PhD</au><au>Zanati, Simon, MBBS, FRACP</au><au>Williams, Stephen J., MBBS, FRACP, MD</au><au>Singh, Rajvinder, MBBS, FRACP, MRCP, FRCP</au><au>Moss, Alan, MBBS, FRACP, MD</au><au>Sonson, Rebecca, BNurs</au><au>Bourke, Michael J., MBBS, FRACP</au><aucorp>The Australian Colonic Endoscopic Mucosal Resection (ACE) Study Group</aucorp><aucorp>Australian Colonic Endoscopic Mucosal Resection (ACE) Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Actual endoscopic versus predicted surgical mortality for treatment of advanced mucosal neoplasia of the colon</atitle><jtitle>Gastrointestinal endoscopy</jtitle><addtitle>Gastrointest Endosc</addtitle><date>2014-10-01</date><risdate>2014</risdate><volume>80</volume><issue>4</issue><spage>668</spage><epage>676</epage><pages>668-676</pages><issn>0016-5107</issn><eissn>1097-6779</eissn><abstract>Background EMR of advanced mucosal neoplasia (AMN) (ie, sessile or laterally spreading lesions of ≥20 mm) of the colon has become an increasingly popular alternative to surgical resection. However, data regarding safety and mortality of EMR in comparison to surgery are limited. Objective To compare actual endoscopic with predicted surgical mortality. Design Prospective, observational, multicenter cohort study. Setting Academic, high-volume, tertiary-care referral center. Patients Consecutive patients referred for EMR. Intervention EMR. Main Outcome Measurements To predict hypothetical surgical mortality, the Association of Coloproctology of Great Britain and Ireland score, composed of physiological and surgical components, was calculated for each patient. Predicted surgical mortality was then compared with actual outcomes of EMR. The results were validated by an unselected subcohort by using the Colorectal Physiologic and Operative Severity Score for Enumeration of Mortality and Morbidity. Results Among 1050 patients with AMN treated by EMR, including patients with a predicted mortality rate of greater than 5% (13.8% of cohort), no deaths occurred within 30 days after the procedure. The predicted surgical mortality rate was 3.3% with the Association of Coloproctology of Great Britain and Ireland score ( P < .0001). This suggests a significant advantage of EMR over surgery. The results were validated by using the Colorectal Physiologic and Operative Severity Score for Enumeration of Mortality and Morbidity in 390 patients predicting a surgical mortality rate of 3.2% ( P = .0003). Limitations Nonrandomized study. Conclusion In this large multicenter study of EMR for colonic AMN, the predicted surgical mortality rate was significantly higher than the actual endoscopic mortality rate. Given that endoscopic therapy is less morbid and less expensive than surgery and can be performed as an outpatient treatment, it should be considered as the first line of treatment for most patients with these lesions.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>24916925</pmid><doi>10.1016/j.gie.2014.04.015</doi><tpages>9</tpages></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Australia Cause of Death Cohort Studies Colonic Neoplasms - mortality Colonic Neoplasms - pathology Colonic Neoplasms - surgery Colonoscopy - methods Colonoscopy - mortality Disease-Free Survival Education, Medical, Continuing Female Gastroenterology and Hepatology Humans Intestinal Mucosa - pathology Intestinal Mucosa - surgery Male Middle Aged Neoplasm Invasiveness - pathology Neoplasm Staging Predictive Value of Tests Prospective Studies Risk Assessment Survival Analysis |
| title | Actual endoscopic versus predicted surgical mortality for treatment of advanced mucosal neoplasia of the colon |
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