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Outcomes of complex colorectal polyps managed by multi-disciplinary team strategies - a multi-centre observational study

Parker, J., Gupta, S., Shenbagaraj, L., Harborne, P., Karandikar, S., Motterhead, M., Barbour, J., Mohammed, N., Lockett, M., Lyons, A., Vega, R., Torkington, J. and Dolwani, S. ORCID: 2023. Outcomes of complex colorectal polyps managed by multi-disciplinary team strategies - a multi-centre observational study. International Journal of Colorectal Disease 38 , 28.

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Purpose Team management strategies for complex colorectal polyps are recommended by professional guidelines. Multi-disciplinary meetings are used across the UK with limited information regarding their impact. The aim of this multi-centre observational study was to assess procedures and outcomes of patients managed using these approaches. Method This was a retrospective, observational study of patients managed by six UK sites. Information was collected regarding procedures and outcomes including length of stay, adverse events, readmissions and cancers. Results Two thousand one hundred ninety-two complex polyps in 2109 patients were analysed with increasing referrals annually. Most presented symptomatically and the mean polyp size was 32.1 mm. Primary interventions included endoscopic therapy (75.6%), conservative management (8.3%), colonic resection (8.1%), trans-anal surgery (6.8%) or combined procedures (1.1%). The number of primary colonic resections decreased over the study period without a reciprocal increase in secondary procedures or recurrence. Secondary procedures were required in 7.8%. The median length of stay for endoscopic procedures was 0 days with 77.5% completed as day cases. Median length of stay was 5 days for colonic resections. Overall adverse event and 30-day readmission rates were 9.0% and 3.3% respectively. Malignancy was identified in 8.8%. Benign polyp recurrence occurred in 13.1% with a median follow up of 30.4 months. Screening detected lesions were more likely to undergo bowel resection. Colonic resection was associated with longer stays, higher adverse events and more cancers on final histology. Conclusion Multi-disciplinary team management of complex polyps is safe and effective. Standardisation of organisation and quality monitoring is needed to continue positive effects on outcomes and services.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: Springer Verlag
ISSN: 0179-1958
Funders: Royal College of Surgeons of England Moondance Research Fellowship
Date of First Compliant Deposit: 16 January 2023
Date of Acceptance: 28 November 2022
Last Modified: 03 May 2023 08:43

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