1. EFFECT OF IMPLEMENTING A REGIONAL REFERRAL NETWORK ON SURGICAL REFERRAL RATE OF BENIGN POLYPS FOUND DURING A COLORECTAL CANCER SCREENING PROGRAM: A POPULATION-BASED STUDY
- Author
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Martin Dahan, Jérémie Jacques, Véronique Loustaud-Ratti, Mickael Crespi, Sophie Geyl, Tessa Tabouret, Paul Carrier, Rebecca Rodrigues, Sylvaine Durand-Fontanier, Abdelkader Taibi, Denis Sautereau, Romain Legros, Jérémie Albouys, Christelle De Carvalho, and Sébastien Kerever
- Subjects
medicine.medical_specialty ,Adenoma ,Referral ,Colorectal cancer ,Population ,Colonoscopy ,Colonic Polyps ,Context (language use) ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Mass Screening ,education ,Referral and Consultation ,Early Detection of Cancer ,education.field_of_study ,Hepatology ,medicine.diagnostic_test ,business.industry ,General surgery ,Network on ,Gastroenterology ,medicine.disease ,Colorectal surgery ,Benign polyps ,Population based study ,Colorectal cancer screening ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Colorectal Neoplasms ,business - Abstract
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%, P0.0001). 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, P0.0001), 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.
- Published
- 2020
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