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THE RATE OF COLECTOMY FOR LARGE BENIGN NEOPLASMS HAS NOTABLY DECREASED OVER THE LAST 18 YEARS, MOSTLY IN THE LAST 5 YEARS. THIS MAY REFLECT AN INCREASE IN THE ENDOSCOPIC MANAGEMENT OF BENIGN LESIONS.
Elizabeth Nilsson Sjolander
*1,2, Neil Mitra
1, Yi-Ru Chen
1, Hmc Shantha Kumara
1, Richard L. Whelan
11Lenox Hill Hospital, New York, NY; 2North Shore University Hospital, Manhasset, NY
Introduction: The endoscopic removal of large adenomas is preferred since the associated cost, morbidity, and mortality is less than colectomy which is the alternative. Whereas in Japan and the Far East, advanced endoscopic methods (ESD, EMR, and hybrid ESD/EMR) are commonly used for these lesions, in the US colectomy is still often employed. To increase US adoption rates, the last decade has seen an increase in the number of advanced endoscopy fellowships (AEF), courses, and programs. There is data suggesting that the number of endoscopic polypectomies has increased in the US. In 2012 there were 51 AEF programs while in 2023 there were 78 (90% offer ESD training). Has this effort led to a decrease in the number of colectomies for benign lesions? To answer this question data from the American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) and National Inpatient Sample (NIS) databases over a 18 year period was analyzed to determine if the treatment of large benign polyps has changed during this period.
Methods: NSQIP colectomy data from 2005 to 2022 was assessed; six 3-year time periods were considered: 2005-2007, 2008-2010, 2011-2013, 2014-2016, 2017-2019, 2020-2022. The number of colectomies in the NSQIP database for these 3 year periods ranged from 28,472 to 186,776 cases. Data from the NIS database, based on hospital discharges, for the 2016-2021 time period was also studied. The yearly colectomy case number during this period ranged from 87,156 to 97,648 per year.
Results: As per the NSQIP data, the percentage of colectomies done for benign disease (benign colectomy rate) in these time blocks are as follows; 8.9% in 2005-2007, 7.5% in 2017-2019 and 5.7% in 2020-2022. The percent change in the benign colectomy rates between these time periods between 2005-2022 based on this NSQIP data was 57% (p<0.0001). When the shorter and more recent 2017-2022 periods are considered separately the percent change in the benign colectomy rate is 32% (p<0.0001). Of note, there was only a 4% change in the benign colectomy rate from 2005 to 2016. As regards the NIS data, a 17% change was found in the rate of benign lesion colectomies from 2016 to 2021 (5.7% to 4.9%, p<0.0001).
Conclusion: Diligent attempts have been made in the last decade to teach and spread advanced colonoscopic methods. This data suggests that there may be an increased awareness of the problem since the number and percentage of benign polyps treated via colectomy in the US has significantly decreased over the 18 year time period studied; the greatest rate of change was noted in the last 5 years. Unfortunately, there is still a large number of colectomies being done for benign polyps. To further decrease the colectomy rate new teaching strategies/approaches are needed to increase the adoption rates of advanced colonoscopic methods in the US.
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