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THE IMPACT OF ENDOLUMINAL SURGERY ON COLORECTAL RESECTIONS FOR BENIGN POLYPS
Kamil Erozkan, Salih N. Karahan
*, Lukas Schabl, Ali Alipouriani, Joshua Sommovilla, Emre Gorgun
Colorectal Surgery, Cleveland Clinic, Cleveland, OH
Background: Endoluminal surgery (ELS) is a promising approach for managing benign colorectal polyps. In centers with a high volume of ELS procedures, there may be changes in the use of colon resection as a treatment option for benign indications. Therefore, we aimed to analyze the changes in postoperative histopathological findings of benign colorectal lesions before and after the implementation of an ELS service line. We hypothesized an increased incidence of postoperative malignancies after implementing the ELS service line at our medical facility.
Methods: Patients with an endoscopic diagnosis of benign adenoma deemed unamenable for endoscopic removal who underwent colectomy between January 2003 and December 2022 were assessed. The exclusion criteria were a preoperative diagnosis of cancer, inherited polyposis syndrome, inflammatory bowel disease, synchronous pathology requiring surgery, and treatment with combined endoscopic laparoscopic surgery. A comparative analysis was conducted between patients treated pre- (2003-2012) and post-ELS era (2013-2022) at a tertiary care center. The primary outcome was the rate of postoperative malignant histopathology.
Results: The study included 696 patients, with a mean age of 65.6 (±10.8) years. Among them, 346 patients (49.7%) were male, with an average BMI of 29.2 (±6.1) m2/kg. Sessile polyps were identified in 585 patients (84.1%), primarily located on the right side of the colon (n=604, 86.7%) (
Table 1)
In the post-ELS era, there was a nearly 50% increase in the number of patients undergoing colectomy for benign indications (280, 40.2% vs. 416, 59.8%). Interestingly, postoperative histopathological findings revealed a lower malignancy rate in the post-ELS era (30, 10.7% vs. 26, 6.3%, p <0.01). However, patients from the external referral were more frequent in the post-ELS ten-year period (66, 23.6% vs 179, 43%, p<0.001). Following the initiation of the ELS service, 95 (22.8%) patients were assessed by surgeons who have ELS experience. Additionally, previous interventions were more common in the post-ELS era (42, 15% vs. 87, 20.9%, p=0.049). Outcomes of colorectal resections are presented in
Table 2 for further details.
Conclusion: The initiation of an ELS service resulted in a higher number of colorectal resections for benign polyps accompanied by a decreased postoperative malignancy rate. The increased patient population might be attributed to referral upsurge after the ELS service. The potential rationale for the reduced incidence of malignancies may be attributed to the enhanced experience in polyp assessment, thereby facilitating the preoperative identification of malignant lesions.
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