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Updated: Jan 9, 2026
Competing-Risk Nomogram for Predicting Cancer-Specific Survival in Multiple Primary Colorectal Cancer Patients after Surgery
Published on: September 27, 2024
"Resect and pool": surveillance interval agreement, safety, and savings from placing all colorectal polyps considered
Easton M Stark1, Rachel E Lahr1, John J Guardiola1
1Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, United States.
Background:
We investigated the effects of collecting all lesions (from all segments) deemed zero risk for cancer in a single bottle for pathology.
Methods:
We performed two prospective evaluations. In phase 1, resected zero-risk lesions from the same segment were collected in the same bottle. The endoscopist predicted surveillance intervals based on lesion size, number, and histology predictions. Predicted intervals were compared with pathology-based intervals. In phase 2 the "resect and pool" strategy was implemented, in which all zero-risk lesions from all segments were collected in a single bottle. End points were proportion of correctly assigned surveillance intervals, safety (no cancers placed with lesions from other segments), and savings (reduction in pathology bottles and carbon emissions).
Results:
In phase 1, 3514 lesions were deemed zero risk, and none had cancer. Of 72 non-zero-risk lesions, 6 (8.3%) had cancer. Endoscopist surveillance intervals were correct in 97.2% (95%CI 95.7%-98.2%) of procedures, and 97.1% (95%CI 95.1%-98.4%) when intervals were determined only by lesions from the current colonoscopy. Phase 2 had 5107 zero-risk lesions, and none had cancer. Combining zero-risk lesions from different segments in a single bottle reduced pathology costs and carbon footprint by 62%-64% compared with zero-risk lesions being separated by colorectal segment.
Conclusions:
When performed by an endoscopist with expertise in optical diagnosis, resect and pool colonoscopy was safe, permitted correct prediction of surveillance intervals, and reduced pathology costs and carbon emissions.
