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What is already known on the subject? Endoscopic resection is the treatment of choice of large benign lesions whatever the size.
What are the new findings? Regional network decreases surgical rate for benign polyps.
How might it impact on clinical practice in the foreseeable future? Implementing technological tools that allow expert's network could considerably decrease surgical rate of benign polyps.
Surgical management is too often performed as the first-line treatment for large, benign colorectal polyps. We report the management of benign lesions detected by organised colorectal cancer (CRC) screening.
Population-based study in 2012, 2016, and 2017, analyzing the evolution of surgical management of benign polyps of≥2cm diameter discovered in the context of organised CRC screening after the implementation of a regional referral network for the management of superficial colorectal lesions.
A total of 1571 patients underwent colonoscopy following a positive test during the study period, among which 981 colonoscopies yielded at least one lesion. The adenoma detection rate was lower in 2012 (Guaiac test) than in 2016 and 2017 (fecal immunochemical test) (40% vs. 60% vs. 57%, P<0.0001). The surgery rate for benign lesions decreased from 14.6% in 2012 to 7.7% in 2016 and 5% in 2017 (P=0.017). The risk factors for surgery for benign lesions were year 2012 (odds ratio [OR]=3.35, P=0.022), high-grade dysplasia (OR=2.49, P=0.04), in situ carcinoma (OR=5, P=0.003), size≥20mm (OR=17.39, P<0.0001), and private sector (OR=6.6, P=0.0002). The morbidity rate of surgery for benign polyp≥2cm was 20.4% at 1month and its cost was sixfold higher than that of endoscopy.
The establishment of a regional referral network for the management of large colorectal polyps reduces the rate of surgical management of such lesions.Le texte complet de cet article est disponible en PDF.
Keywords : Colorectal cancer, ESD, EMR, Colorectal surgery