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

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.