Referrals for surgical removal of polyps since the introduction of a colorectal cancer screening program

Colorectal Cancer

Colorectal Dis. 2020 Oct 27. doi: 10.1111/codi.15413. Online ahead of print.


AIM: Implementation of the national bowel screening program in 2014 led to an increased detection rate of polyps. In general, polyps should be removed endoscopically. However, if the size and location of the polyp makes endoscopic removal technically difficult or if there is a suspicion for early (T1) cancer, surgery is the preferred method for removal. An increasing number of these patients are treated with minimal invasive surgical procedures instead of a segmental resection. The aim of our study was to assess the number of referrals for surgery and the type of surgery for polyps since the introduction of the national bowel screening program.

METHODS: A retrospective cohort study was performed. Patients who underwent surgery for colorectal polyps between January 2012 and December 2017 were included. Exclusion criteria were histologically proven carcinoma prior to surgery. Primary outcomes were number and type of surgical procedures for polyps.

RESULTS: In total, 164 patients were included. An annual increase of procedures for colorectal polyps was observed, from 18 patients in 2012 to 36 patients in 2017. All the procedures before implementation of the screening program were segmental resections and 58.8% of the patients underwent organ preserving surgery after implementation of the screening. Overall complication rate of organ preserving surgery was 16.3%, compared to 44.3% of segmental resections (p = 0.001). Overall invasive colorectal cancer was encountered in 23.8% of cases.

CONCLUSIONS: The number of referrals for surgical resection of colorectal polyps has doubled since the introduction of the CRC screening program with a substantial shift towards organ preserving techniques.