An evidence-based treatment algorithm for colorectal polyp cancers: Results from the Scottish Screen-detected Polyp Cancer Study (SSPoCS)

C. H. Richards (Corresponding Author), N. T. Ventham, D. Mansouri, M. Wilson, G. Ramsay, C. D. MacKay, C. N. Parnaby, D. Smith, J. On, D. Speake, G. McFarlane, Y. N. Neo, E. Aitken, C. Forrest, K. Knight, A. McKay, H. Nair, C. Mulholland, J. H. Robertson, F. A. Carey & 2 others R. J.C. Steele, The Scottish Surgical Research Group

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Objectives Colorectal 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. Design This 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. Results 485 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). Conclusion A 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.

Original languageEnglish
Pages (from-to)299-306
Number of pages8
JournalGut
Volume67
Issue number2
Early online date27 Oct 2016
DOIs
Publication statusPublished - Feb 2018

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Polyps
Colorectal Neoplasms
Neoplasms
Residual Neoplasm
Therapeutics
Cohort Studies
Multivariate Analysis
Lymph Nodes
Regression Analysis
Neoplasm Metastasis
Recurrence

Keywords

  • CANCER
  • COLORECTAL CANCER SCREENING
  • POLYP
  • SURVEILLANCE

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Richards, C. H., Ventham, N. T., Mansouri, D., Wilson, M., Ramsay, G., MacKay, C. D., ... The Scottish Surgical Research Group (2018). An evidence-based treatment algorithm for colorectal polyp cancers: Results from the Scottish Screen-detected Polyp Cancer Study (SSPoCS). Gut, 67(2), 299-306. https://doi.org/10.1136/gutjnl-2016-312201

An evidence-based treatment algorithm for colorectal polyp cancers : Results from the Scottish Screen-detected Polyp Cancer Study (SSPoCS). / Richards, C. H. (Corresponding Author); Ventham, N. T.; Mansouri, D.; Wilson, M.; Ramsay, G.; MacKay, C. D.; Parnaby, C. N.; Smith, D.; On, J.; Speake, D.; McFarlane, G.; Neo, Y. N.; Aitken, E.; Forrest, C.; Knight, K.; McKay, A.; Nair, H.; Mulholland, C.; Robertson, J. H.; Carey, F. A.; Steele, R. J.C.; The Scottish Surgical Research Group.

In: Gut, Vol. 67, No. 2, 02.2018, p. 299-306.

Research output: Contribution to journalArticle

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 & The Scottish Surgical Research Group 2018, 'An evidence-based treatment algorithm for colorectal polyp cancers: Results from the Scottish Screen-detected Polyp Cancer Study (SSPoCS)' Gut, vol. 67, no. 2, pp. 299-306. https://doi.org/10.1136/gutjnl-2016-312201
Richards, C. H. ; Ventham, N. T. ; Mansouri, D. ; Wilson, M. ; Ramsay, G. ; MacKay, C. D. ; Parnaby, C. N. ; Smith, D. ; On, J. ; Speake, D. ; McFarlane, G. ; Neo, Y. N. ; Aitken, E. ; Forrest, C. ; Knight, K. ; McKay, A. ; Nair, H. ; Mulholland, C. ; Robertson, J. H. ; Carey, F. A. ; Steele, R. J.C. ; The Scottish Surgical Research Group. / An evidence-based treatment algorithm for colorectal polyp cancers : Results from the Scottish Screen-detected Polyp Cancer Study (SSPoCS). In: Gut. 2018 ; Vol. 67, No. 2. pp. 299-306.
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abstract = "Objectives Colorectal 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. Design This 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. Results 485 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). Conclusion A 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.",
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note = "Acknowledgements Members of the SSRG thank the steering committee of the Scottish Bowel Screening Programme for permitting and supporting this study. In particular, the authors are grateful to Jaroslaw Lang and Greig Stanners for providing data from the Bowel Screening Scotland database. Finally, the authors also thank all the clinicians who contributed data from hospitals around Scotland. Without this level of collaboration, the study would not have been possible.",
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T1 - An evidence-based treatment algorithm for colorectal polyp cancers

T2 - Results from the Scottish Screen-detected Polyp Cancer Study (SSPoCS)

AU - Richards, C. H.

AU - Ventham, N. T.

AU - Mansouri, D.

AU - Wilson, M.

AU - Ramsay, G.

AU - MacKay, C. D.

AU - Parnaby, C. N.

AU - Smith, D.

AU - On, J.

AU - Speake, D.

AU - McFarlane, G.

AU - Neo, Y. N.

AU - Aitken, E.

AU - Forrest, C.

AU - Knight, K.

AU - McKay, A.

AU - Nair, H.

AU - Mulholland, C.

AU - Robertson, J. H.

AU - Carey, F. A.

AU - Steele, R. J.C.

AU - The Scottish Surgical Research Group

N1 - Acknowledgements Members of the SSRG thank the steering committee of the Scottish Bowel Screening Programme for permitting and supporting this study. In particular, the authors are grateful to Jaroslaw Lang and Greig Stanners for providing data from the Bowel Screening Scotland database. Finally, the authors also thank all the clinicians who contributed data from hospitals around Scotland. Without this level of collaboration, the study would not have been possible.

PY - 2018/2

Y1 - 2018/2

N2 - Objectives Colorectal 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. Design This 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. Results 485 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). Conclusion A 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.

AB - Objectives Colorectal 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. Design This 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. Results 485 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). Conclusion A 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.

KW - CANCER

KW - COLORECTAL CANCER SCREENING

KW - POLYP

KW - SURVEILLANCE

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U2 - 10.1136/gutjnl-2016-312201

DO - 10.1136/gutjnl-2016-312201

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JO - Gut

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