Significant variation in the assessment and management of screen-detected colorectal polyp cancers

Endoscopic resection is appropriate for selected colorectal polyp cancers, but significant variation exists in treatment. This study aims to investigate variation in management of screen-detected polyp cancers (T1), factors predicting primary endoscopic polypectomy and threshold for subsequent surgical resection.

Patients with polyp cancers (T1) diagnosed by the bowel cancer screening programme (BCSP) were investigated at two screening centres (5 individual sites and 4 MDTs, 2012-2022). Patient demographics, pathological characteristics, management and outcomes were recorded. Variation in management was compared between sites. Risk factors for primary endoscopic polypectomy and the need for subsequent surgical resection were analysed using multivariable binary logistic regression models.

Of 220 polyp cancers, 178 (81%) underwent primary endoscopic resection. Secondary surgical excision was required in 54 (30%). Study sites were not significantly different in their primary management for colonic or rectal polyps. Only the size of colonic polyps was associated with primary surgery rather than endoscopic polypectomy (OR 1.05 (95% CI 1.00-1.11); p = 0.038). There was a difference between study sites in the odds ratio for secondary surgery after primary polypectomy for colonic polyps (OR 3.97 (95% CI 1.20-16.0); p = 0.033) but not rectal. Other factors associated with the requirement for secondary surgery were as follows: sessile morphology for colonic polyps (OR 2.92 (95% CI 1.25-6.97); p = 0.013) and en-bloc resection for rectal polyps (OR 0.14 (0.02-0.85); p = 0.043).

There was significant variation in the assessment and treatment of colonic polyp cancers. Standardising pathology reporting and treatment algorithms may lead to better consistency of care and a reduction in secondary surgery.