IS COLECTOMY FOR NON-MALIGNANT POLYPS OVERUTILIZED? A WORD OF CAUTION FROM NATIONWIDE PATIENT SAMPLE
TB Cengiz, MA Valente, J Church, CP Delaney, E Gorgun
Cleveland Clinic Foundation
Colectomy for non-malignant polyps (NMPs) is a relatively common procedure, and yet rates of underlying cancer tend to be less than 20%. These patients undergo major surgery, and potentially have a slow or complicated recovery. In this study, we aimed to assess the rate of colectomies performed for NMPs, using a nationwide patient sample, in order to develop evidence to discuss the best methodology of treatment.
The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to include patients who underwent colectomy between 2013 and 2016. All patients who underwent surgery for “NMPs” were identified and miscoded patients were excluded from the analysis. Patient demographics and the postoperative complications after colectomy for NMPs were assessed.
A total of 138,521 patients were identified, of whom 9725 (7%) underwent colectomy for NMPs. Mean age was 63.6 years, 49.2% of the patients were male and the mean BMI was 29.2 kg/m2. Minimally invasive surgery was performed in 88% of the patients. Only 296 patients(3%) had underlying invasive colon cancer and the rates of T1, T2, T3 and T4 lesions were 1.6%, 0.6%, 0.5%, and 0.1%, respectively. 51 patients(0.5%) had lymph node involvement. Mean operative time was 153 minutes and mean hospital stay was 4.8 days. The anastomotic leak rate was 2.6%, overall postoperative morbidity rate was 12.6%, readmission rate was 7.9% and reoperation rate was 3.2%.
Review of the ACS-NSQIP colectomy-targeted database shows that for NMPs not amenable to endoscopic resection, colectomy may be unnecessary as underlying invasive cancer rates are low. These rates are much lower than expected from prior retrospective series. Patients frequently suffer significant morbidities. We recommend that patients with NMP are seen by an endoscopist familiar with advanced endoscopic polypectomy skills prior to making a decision for a bowel resection.
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