Incidental Polyp on Colectomy Specimen is Linked with Higher Odds of Polyp on Interval Colonoscopy.

BACKGROUND: Incidentally found polyps on surgical pathology after colectomy is an underreported phenomenon, and management guidelines are lacking. Elucidation of the significance of incidental polyps is needed to determine if post-operative endoscopic surveillance modification is warranted. We sought to determine the relationship between incidental polyp on colectomy specimen and findings on post-operative colonoscopy. MATERIALS AND METHODS: A multi-institutional retrospective review was performed on patients that underwent colorectal resection from 2018-2019. Surgical pathology was reviewed for polyps and assigned as expected or incidental based on pre-operative colonoscopy. If performed, post-operative colonoscopy was reviewed for new lesion identification. The odds of detecting new lesion on post-operative colonoscopy was compared between cases with incidental polyp on surgical specimen and patients without incidental findings. RESULTS: In 243 colorectal resections, incidental polyps were identified in 55 cases (22.6%). Post-operative colonoscopy was completed in 65 cases (26.7%) with new polyp detected in 24 cases (9.88%). Of those, 10 had an incidental polyp previously identified on surgical specimen while 14 did not. The presence of incidental surgical specimen polyp was associated with a greater than two-fold higher odds of detecting new polyp on post-operative colonoscopy (odds-ratio 2.76, 95% confidence interval 1.15-6.63;P = 0.023). CONCLUSION: This analysis revealed a high frequency of incidental polyps on surgical specimens with an increased rate of newly found lesions on post-operative colonoscopy. Incidental polyps may be a risk factor for other missed lesions still within the patient. Therefore, providers should consider surveillance interval modification on an individual basis in the setting of incidental surgical specimen polyps.

Incisional Hernias After Major Abdominal Operations: Analysis Within a Large Health Care System.

BACKGROUND: This will be the largest multi-institutional study looking at incidence of and duration to symptomatic hernia formation for major abdominal operations separated by malignant and benign disease process. METHODS: An IRB-approved retrospective study within the MedStar Hospital database was conducted, incorporating all isolated colectomy, hepatectomy, pancreatectomy, and gastrectomy procedures between the years 2002 and 2016. All patients were identified using ICD-9 and ICD-10 codes for relevant procedures, and then separated based on malignant or benign etiology. The rate of symptomatic incisional hernia rates was determined for each cohort based on subsequent hernia procedural codes identified. RESULTS: During this 15-year span, a total of 6448 major abdominal operations were performed at all 10 institutions, comprising 3835 colectomies, 1122 hepatectomies, 1165 pancreatectomies, and 326 gastrectomies. Total incidence of symptomatic incisional hernia occurrence requiring repair was 325 (5.0%). Separated by group, the overall incisional hernia repair rates for patients undergoing colectomy, hepatectomy, pancreatectomy, and gastrectomy are as follows, respectively: 6.4% (247), 2.5% (28), 3.6% (42), and 2.8% (9), P < 0.0001. The subsequent median duration to hernia repair was 498 d (interquartile range [IQR]: 312-924) for colectomy, 421 d (IQR: 340-518) for hepatectomy, 378 d (IQR: 284-527) for pancreatectomy, and 630 d (IQR: 419-1204) for gastrectomy (P = 0.03401). CONCLUSIONS: Symptomatic incisional hernia repair rates after major gastrointestinal and hepatobiliary surgery range from 2.1% to 6.4%. There was no significant increase in hernia rates in patients undergoing surgery for malignancy.

Minimally Invasive Surgery for Colorectal Cancer: Hospital Type Drives Utilization and Outcomes.

INTRODUCTION: Minimally invasive surgery (MIS) for colorectal cancer (CRC) is increasingly common; however, uptake has differed by hospital type. It is unknown how these trends have evolved for laparoscopic or robotic approaches in different types of hospitals. This study assesses temporal trends for MIS utilization and examines differences in surgical outcomes by hospital type. METHODS: The National Cancer Database was queried for patients who underwent CRC surgery between 2010 and 2015. Time-trend analysis of MIS utilization was performed for both approaches by hospital type (community, comprehensive community, integrated network, academic). Multivariate logistic regression models were used to examine MIS utilization, differences in case severity, and surgical outcomes by hospital type, after controlling for patient characteristics. RESULTS: Across all hospital types, community hospitals had the lowest rate of laparoscopic (36.8%) and robotic (3.3%) procedures for CRC (P < 0.001). Community hospitals also exhibited a significant lag in adoption rate of robotic surgery (colon = 0.84% versus 1.41%/y; rectum = 2.14% versus 3.88 %/y). Community hospitals performing MIS had worse outcomes, including the most frequent conversions to open (colon = 15.2%; rectal = 17.1%) and highest 90-day mortality (colon = 6%; rectal = 3.2%) (P < 0.001). Finally, compared with laparoscopic colon surgery at academic centers, community centers treated lower grade tumors (OR 0.938, P < 0.05) with higher 30-day (OR 1.332, P < 0.05) and 90-day mortality (OR 1.210, P < 0.05). CONCLUSIONS: MIS for CRC lags at the community level and experiences worse postoperative outcomes. Future initiatives must focus on understanding and correcting this trend to ensure uniform access to high-quality surgical care.