EFFECT OF IMPLEMENTING A REGIONAL REFERRAL NETWORK ON SURGICAL REFERRAL RATE OF BENIGN POLYPS FOUND DURING A COLORECTAL CANCER SCREENING PROGRAM: A POPULATION-BASED STUDY

Aims Surgical management is too often performed as a first-line treatment for large benign colorectal polyps. We report the evolution of the management of benign lesions detected in organized colorectal cancer (CRC) screening.

Methods We carried out a population-based study, using the years 2012, 2016 and 2017 in order to compare the results of management of benign colorectal lesions since from 2016 a regional referral network has been implemented in our geographic area.

The main objective was to compare the evolution of the surgical management rate for benign lesions before and after the development of a regional referral network with experts in interventional endoscopy.

Results 1571 patients had a colonoscopy following a positive test, 981 colonoscopies showed at least one lesion.

The adenoma detection rate was 57%, lower for the 2012 tests (Hemoccult II) at 40% compared to 62% and 57.5% in 2016 and 2017 (FIT) (p< 0.0001).

The surgical management rate for benign lesions decreased significantly,from 14.6% in 2012 to 7.5% in 2016 and 5% in 2017 (p=0.016).

Surgical management of benign lesions was significantly more important in the private sector (10% compared to 2.8%, p=0.001) but tends to decrease.

The risk factors for surgery for benign lesions were year 2012 (OR:3.35, p=0.22), high-grade dysplasia (OR:2.49, p=0.04), in situ carcinoma (OR:5, p=0.003), size ≥20mm

(OR:17.39, p< 0.0001), private sector (OR:6.6, p=0.0002).

Morbidity at one month for benign lesions over 20 mm was 20.4% (versus 6% with endoscopy, p=0.044) and the cost was 6 times higher with surgery (7197.7 euros (+/- 3018) versus 1128.6 euros (+/- 353), p< 0.0001).

Conclusions This study is the first to demonstrate a direct life and cost saving effect of the establishment of a specialized regional network for large superficial benign colorectal lesions. However, benign lesions directly send to surgeons are too frequent and absolutely need to be avoid.