Overtreatment in colorectal cancer prevention: comparison between surgical and endoscopic treatment of benign colonic polyps
Background: The growing number of premalignant colonic lesions undergoing surgical treatment can lead to increased overtreatment. Objectives: We assessed the magnitude of overtreatment by comparing rates of adverse events related to surgical and endoscopic treatment of complex benign polyps. Design:...
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2025-08-01
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| Series: | Therapeutic Advances in Gastroenterology |
| Online Access: | https://doi.org/10.1177/17562848251351214 |
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| author | Noelia Sala-Miquel Lucía Medina-Prado Carolina Mangas-Sanjuan Sandra Baile-Maxía Cristina Alenda Lucía Madero-Velázquez Francisco A. Ruiz-Gómez Eva Serrano Enrique Santana Victor Ausina María Sáez-Rico Pedro Zapater Juan Martínez-Sempere Rodrigo Jover |
| author_facet | Noelia Sala-Miquel Lucía Medina-Prado Carolina Mangas-Sanjuan Sandra Baile-Maxía Cristina Alenda Lucía Madero-Velázquez Francisco A. Ruiz-Gómez Eva Serrano Enrique Santana Victor Ausina María Sáez-Rico Pedro Zapater Juan Martínez-Sempere Rodrigo Jover |
| author_sort | Noelia Sala-Miquel |
| collection | DOAJ |
| description | Background: The growing number of premalignant colonic lesions undergoing surgical treatment can lead to increased overtreatment. Objectives: We assessed the magnitude of overtreatment by comparing rates of adverse events related to surgical and endoscopic treatment of complex benign polyps. Design: This was a single-center retrospective study conducted at a tertiary care hospital. Methods: This study included patients with benign colonic lesions treated surgically during 2005–2021 and compared with a cohort with complex lesions (Size, Morphology, Site, and Access (SMSA) ⩾3) treated endoscopically during 2018–2022. Adverse events, need for reintervention, mortality, and length of hospital stay were compared using propensity score (PS)-matching analysis. The cohorts were matched 1:1 with adjustment for sex, age, SMSA, and size as covariates. Surgical and endoscopic adverse events were described using the Clavien–Dindo (surgical group) and AGREE (endoscopic group) classifications. Results: Of 240 included patients, PS matching yielded 71 pairs. Adverse events were more frequent with surgical treatment (odds ratio (OR) 3.27; 95% confidence interval (CI) 1.59–6.71), as were severe adverse events (OR 7.5; 95% CI 2.1–27.0), need for reintervention (OR 25.6; 95% CI 3.3–200.0), and mean length of hospital stay (10 vs 0 days, p < 0.001). One (1.4%) patient in the surgical group and none in the endoscopic group died ( p = 0.39). Conclusion: An excess of severe adverse events with surgical treatment of complex benign polyps reflects overtreatment. Adequate pathways must be established for referral of these lesions for endoscopic treatment. |
| format | Article |
| id | doaj-art-8da31ff9ab384397b318bf8bdf4d46d8 |
| institution | DOAJ |
| issn | 1756-2848 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Gastroenterology |
| spelling | doaj-art-8da31ff9ab384397b318bf8bdf4d46d82025-08-20T02:56:43ZengSAGE PublishingTherapeutic Advances in Gastroenterology1756-28482025-08-011810.1177/17562848251351214Overtreatment in colorectal cancer prevention: comparison between surgical and endoscopic treatment of benign colonic polypsNoelia Sala-MiquelLucía Medina-PradoCarolina Mangas-SanjuanSandra Baile-MaxíaCristina AlendaLucía Madero-VelázquezFrancisco A. Ruiz-GómezEva SerranoEnrique SantanaVictor AusinaMaría Sáez-RicoPedro ZapaterJuan Martínez-SempereRodrigo JoverBackground: The growing number of premalignant colonic lesions undergoing surgical treatment can lead to increased overtreatment. Objectives: We assessed the magnitude of overtreatment by comparing rates of adverse events related to surgical and endoscopic treatment of complex benign polyps. Design: This was a single-center retrospective study conducted at a tertiary care hospital. Methods: This study included patients with benign colonic lesions treated surgically during 2005–2021 and compared with a cohort with complex lesions (Size, Morphology, Site, and Access (SMSA) ⩾3) treated endoscopically during 2018–2022. Adverse events, need for reintervention, mortality, and length of hospital stay were compared using propensity score (PS)-matching analysis. The cohorts were matched 1:1 with adjustment for sex, age, SMSA, and size as covariates. Surgical and endoscopic adverse events were described using the Clavien–Dindo (surgical group) and AGREE (endoscopic group) classifications. Results: Of 240 included patients, PS matching yielded 71 pairs. Adverse events were more frequent with surgical treatment (odds ratio (OR) 3.27; 95% confidence interval (CI) 1.59–6.71), as were severe adverse events (OR 7.5; 95% CI 2.1–27.0), need for reintervention (OR 25.6; 95% CI 3.3–200.0), and mean length of hospital stay (10 vs 0 days, p < 0.001). One (1.4%) patient in the surgical group and none in the endoscopic group died ( p = 0.39). Conclusion: An excess of severe adverse events with surgical treatment of complex benign polyps reflects overtreatment. Adequate pathways must be established for referral of these lesions for endoscopic treatment.https://doi.org/10.1177/17562848251351214 |
| spellingShingle | Noelia Sala-Miquel Lucía Medina-Prado Carolina Mangas-Sanjuan Sandra Baile-Maxía Cristina Alenda Lucía Madero-Velázquez Francisco A. Ruiz-Gómez Eva Serrano Enrique Santana Victor Ausina María Sáez-Rico Pedro Zapater Juan Martínez-Sempere Rodrigo Jover Overtreatment in colorectal cancer prevention: comparison between surgical and endoscopic treatment of benign colonic polyps Therapeutic Advances in Gastroenterology |
| title | Overtreatment in colorectal cancer prevention: comparison between surgical and endoscopic treatment of benign colonic polyps |
| title_full | Overtreatment in colorectal cancer prevention: comparison between surgical and endoscopic treatment of benign colonic polyps |
| title_fullStr | Overtreatment in colorectal cancer prevention: comparison between surgical and endoscopic treatment of benign colonic polyps |
| title_full_unstemmed | Overtreatment in colorectal cancer prevention: comparison between surgical and endoscopic treatment of benign colonic polyps |
| title_short | Overtreatment in colorectal cancer prevention: comparison between surgical and endoscopic treatment of benign colonic polyps |
| title_sort | overtreatment in colorectal cancer prevention comparison between surgical and endoscopic treatment of benign colonic polyps |
| url | https://doi.org/10.1177/17562848251351214 |
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