An evidence-based treatment algorithm for colorectal polyp cancers: results from the Scottish Screen-detected Polyp Cancer Study (SSPoCS)
ObjectivesColorectal 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. The aim of this study was to develop a treatment algorithm for patients with...
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| Veröffentlicht in: | Gut 2018-02, Vol.67 (2), p.299-306 |
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| creator | Richards, CH Ventham, NT Mansouri, D Wilson, M Ramsay, G Mackay, CD Parnaby, CN Smith, D On, J Speake, D McFarlane, G Neo, YN Aitken, E Forrest, C Knight, K McKay, A Nair, H Mulholland, C Robertson, JH Carey, FA Steele, RJC |
| description | ObjectivesColorectal 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. The aim of this study was to develop a treatment algorithm for patients with screen-detected polyp cancers.DesignThis national cohort study included all patients with a polyp cancer identified through the Scottish Bowel Screening Programme between 2000 and 2012. Multivariate regression analysis was used to assess the impact of clinical, endoscopic and pathological variables on the rate of adverse events (residual tumour in patients undergoing segmental resection or cancer-related death or disease recurrence in any patient). These data were used to develop a clinically relevant treatment algorithm.Results485 patients with polyp cancers were included. 186/485 (38%) underwent segmental resection and residual tumour was identified in 41/186 (22%). The only factor associated with an increased risk of residual tumour in the bowel wall was incomplete excision of the original polyp (OR 5.61, p=0.001), while only lymphovascular invasion was associated with an increased risk of lymph node metastases (OR 5.95, p=0.002). 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 10.23, p |
| doi_str_mv | 10.1136/gutjnl-2016-312201 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1835003469</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1835003469</sourcerecordid><originalsourceid>FETCH-LOGICAL-b413t-3137a5f0f85715a85508051af38b971cd7f6d2655bfffe36b15808cc10f2bedb3</originalsourceid><addsrcrecordid>eNqNkcFu1DAQhi1ERbeFF-CALHEphxQ7jmOHW7WCFqkSlQJny3bG3ayceLEdpH0E3hq3aTlw4jRz-L5fM_oRekvJJaWs_Xi_5P3sq5rQtmK0LvMF2tCmlRWrpXyJNoRQUXHRdKfoLKU9IUTKjr5Cp7UQsmu53KDfVzOGX-MAs4XK6AQDzhF0nmDOWPv7EMe8m7ALEdvgQwSbtceH4I8HbHWRYvqEI6TF54RdDBPOO8C9DTmPaVeWCDBXA-Qiluy7R3H7KOI-L8MRX_T9Xdj2H16jE6d9gjdP8xz9-PL5-_amuv12_XV7dVuZhrJcHmVCc0ec5IJyLTknknCqHZOmE9QOwrVD3XJunHPAWkO5JNJaSlxtYDDsHF2suYcYfi6QsprGZMF7PUNYkqKScUJY03YFff8Pug9LnMt1qiaNJIJ3jBWqXikbQ0oRnDrEcdLxqChRD0WptSj1UJRaiyrSu6foxUww_FWemylAtQJm2v9P4B9-TZ9F</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2048075933</pqid></control><display><type>article</type><title>An evidence-based treatment algorithm for colorectal polyp cancers: results from the Scottish Screen-detected Polyp Cancer Study (SSPoCS)</title><source>PubMed Central</source><creator>Richards, CH ; Ventham, NT ; Mansouri, D ; Wilson, M ; Ramsay, G ; Mackay, CD ; Parnaby, CN ; Smith, D ; On, J ; Speake, D ; McFarlane, G ; Neo, YN ; Aitken, E ; Forrest, C ; Knight, K ; McKay, A ; Nair, H ; Mulholland, C ; Robertson, JH ; Carey, FA ; Steele, RJC</creator><creatorcontrib>Richards, CH ; Ventham, NT ; Mansouri, D ; Wilson, M ; Ramsay, G ; Mackay, CD ; Parnaby, CN ; Smith, D ; On, J ; Speake, D ; McFarlane, G ; Neo, YN ; Aitken, E ; Forrest, C ; Knight, K ; McKay, A ; Nair, H ; Mulholland, C ; Robertson, JH ; Carey, FA ; Steele, RJC ; Scottish Surgical Research Group</creatorcontrib><description>ObjectivesColorectal 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. The aim of this study was to develop a treatment algorithm for patients with screen-detected polyp cancers.DesignThis national cohort study included all patients with a polyp cancer identified through the Scottish Bowel Screening Programme between 2000 and 2012. Multivariate regression analysis was used to assess the impact of clinical, endoscopic and pathological variables on the rate of adverse events (residual tumour in patients undergoing segmental resection or cancer-related death or disease recurrence in any patient). These data were used to develop a clinically relevant treatment algorithm.Results485 patients with polyp cancers were included. 186/485 (38%) underwent segmental resection and residual tumour was identified in 41/186 (22%). The only factor associated with an increased risk of residual tumour in the bowel wall was incomplete excision of the original polyp (OR 5.61, p=0.001), while only lymphovascular invasion was associated with an increased risk of lymph node metastases (OR 5.95, p=0.002). 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 10.23, p<0.001) or lymphovascular invasion (OR 2.65, p=0.023).ConclusionA 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.</description><identifier>ISSN: 0017-5749</identifier><identifier>EISSN: 1468-3288</identifier><identifier>DOI: 10.1136/gutjnl-2016-312201</identifier><identifier>PMID: 27789658</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Algorithms ; Cancer ; Colorectal cancer ; Decision making ; Endoscopy ; Gastroenterology ; Intestine ; Lymph nodes ; Medical prognosis ; Medical screening ; Metastases ; Mortality ; Patients ; Population ; Surgical outcomes ; Surveillance ; Systematic review ; Tumors</subject><ispartof>Gut, 2018-02, Vol.67 (2), p.299-306</ispartof><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.</rights><rights>Copyright: 2016 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b413t-3137a5f0f85715a85508051af38b971cd7f6d2655bfffe36b15808cc10f2bedb3</citedby><cites>FETCH-LOGICAL-b413t-3137a5f0f85715a85508051af38b971cd7f6d2655bfffe36b15808cc10f2bedb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27789658$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Richards, CH</creatorcontrib><creatorcontrib>Ventham, NT</creatorcontrib><creatorcontrib>Mansouri, D</creatorcontrib><creatorcontrib>Wilson, M</creatorcontrib><creatorcontrib>Ramsay, G</creatorcontrib><creatorcontrib>Mackay, CD</creatorcontrib><creatorcontrib>Parnaby, CN</creatorcontrib><creatorcontrib>Smith, D</creatorcontrib><creatorcontrib>On, J</creatorcontrib><creatorcontrib>Speake, D</creatorcontrib><creatorcontrib>McFarlane, G</creatorcontrib><creatorcontrib>Neo, YN</creatorcontrib><creatorcontrib>Aitken, E</creatorcontrib><creatorcontrib>Forrest, C</creatorcontrib><creatorcontrib>Knight, K</creatorcontrib><creatorcontrib>McKay, A</creatorcontrib><creatorcontrib>Nair, H</creatorcontrib><creatorcontrib>Mulholland, C</creatorcontrib><creatorcontrib>Robertson, JH</creatorcontrib><creatorcontrib>Carey, FA</creatorcontrib><creatorcontrib>Steele, RJC</creatorcontrib><creatorcontrib>Scottish Surgical Research Group</creatorcontrib><title>An evidence-based treatment algorithm for colorectal polyp cancers: results from the Scottish Screen-detected Polyp Cancer Study (SSPoCS)</title><title>Gut</title><addtitle>Gut</addtitle><description>ObjectivesColorectal 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. The aim of this study was to develop a treatment algorithm for patients with screen-detected polyp cancers.DesignThis national cohort study included all patients with a polyp cancer identified through the Scottish Bowel Screening Programme between 2000 and 2012. Multivariate regression analysis was used to assess the impact of clinical, endoscopic and pathological variables on the rate of adverse events (residual tumour in patients undergoing segmental resection or cancer-related death or disease recurrence in any patient). These data were used to develop a clinically relevant treatment algorithm.Results485 patients with polyp cancers were included. 186/485 (38%) underwent segmental resection and residual tumour was identified in 41/186 (22%). The only factor associated with an increased risk of residual tumour in the bowel wall was incomplete excision of the original polyp (OR 5.61, p=0.001), while only lymphovascular invasion was associated with an increased risk of lymph node metastases (OR 5.95, p=0.002). 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 10.23, p<0.001) or lymphovascular invasion (OR 2.65, p=0.023).ConclusionA 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.</description><subject>Algorithms</subject><subject>Cancer</subject><subject>Colorectal cancer</subject><subject>Decision making</subject><subject>Endoscopy</subject><subject>Gastroenterology</subject><subject>Intestine</subject><subject>Lymph nodes</subject><subject>Medical prognosis</subject><subject>Medical screening</subject><subject>Metastases</subject><subject>Mortality</subject><subject>Patients</subject><subject>Population</subject><subject>Surgical outcomes</subject><subject>Surveillance</subject><subject>Systematic 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LTD</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>M7P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>201802</creationdate><title>An evidence-based treatment algorithm for colorectal polyp cancers: results from the Scottish Screen-detected Polyp Cancer Study (SSPoCS)</title><author>Richards, CH ; Ventham, NT ; Mansouri, D ; Wilson, M ; Ramsay, G ; Mackay, CD ; Parnaby, CN ; Smith, D ; On, J ; Speake, D ; McFarlane, G ; Neo, YN ; Aitken, E ; Forrest, C ; Knight, K ; McKay, A ; Nair, H ; Mulholland, C ; Robertson, JH ; Carey, FA ; Steele, RJC</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b413t-3137a5f0f85715a85508051af38b971cd7f6d2655bfffe36b15808cc10f2bedb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Algorithms</topic><topic>Cancer</topic><topic>Colorectal cancer</topic><topic>Decision making</topic><topic>Endoscopy</topic><topic>Gastroenterology</topic><topic>Intestine</topic><topic>Lymph nodes</topic><topic>Medical prognosis</topic><topic>Medical screening</topic><topic>Metastases</topic><topic>Mortality</topic><topic>Patients</topic><topic>Population</topic><topic>Surgical outcomes</topic><topic>Surveillance</topic><topic>Systematic 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Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Gut</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Richards, CH</au><au>Ventham, NT</au><au>Mansouri, D</au><au>Wilson, M</au><au>Ramsay, G</au><au>Mackay, CD</au><au>Parnaby, CN</au><au>Smith, D</au><au>On, J</au><au>Speake, D</au><au>McFarlane, G</au><au>Neo, YN</au><au>Aitken, E</au><au>Forrest, C</au><au>Knight, K</au><au>McKay, A</au><au>Nair, H</au><au>Mulholland, C</au><au>Robertson, JH</au><au>Carey, FA</au><au>Steele, RJC</au><aucorp>Scottish Surgical Research Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>An evidence-based treatment algorithm for colorectal polyp cancers: results from the Scottish Screen-detected Polyp Cancer Study (SSPoCS)</atitle><jtitle>Gut</jtitle><addtitle>Gut</addtitle><date>2018-02</date><risdate>2018</risdate><volume>67</volume><issue>2</issue><spage>299</spage><epage>306</epage><pages>299-306</pages><issn>0017-5749</issn><eissn>1468-3288</eissn><abstract>ObjectivesColorectal 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. The aim of this study was to develop a treatment algorithm for patients with screen-detected polyp cancers.DesignThis national cohort study included all patients with a polyp cancer identified through the Scottish Bowel Screening Programme between 2000 and 2012. Multivariate regression analysis was used to assess the impact of clinical, endoscopic and pathological variables on the rate of adverse events (residual tumour in patients undergoing segmental resection or cancer-related death or disease recurrence in any patient). These data were used to develop a clinically relevant treatment algorithm.Results485 patients with polyp cancers were included. 186/485 (38%) underwent segmental resection and residual tumour was identified in 41/186 (22%). The only factor associated with an increased risk of residual tumour in the bowel wall was incomplete excision of the original polyp (OR 5.61, p=0.001), while only lymphovascular invasion was associated with an increased risk of lymph node metastases (OR 5.95, p=0.002). 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 10.23, p<0.001) or lymphovascular invasion (OR 2.65, p=0.023).ConclusionA 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.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>27789658</pmid><doi>10.1136/gutjnl-2016-312201</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Algorithms Cancer Colorectal cancer Decision making Endoscopy Gastroenterology Intestine Lymph nodes Medical prognosis Medical screening Metastases Mortality Patients Population Surgical outcomes Surveillance Systematic review Tumors |
| title | An evidence-based treatment algorithm for colorectal polyp cancers: results from the Scottish Screen-detected Polyp Cancer Study (SSPoCS) |
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