ABSTRACT
OBJECTIVES: Colorectal polyp cancers present clinicians with a treatment dilemma. Decisions regarding whether to offer segmental resection or endoscopic surveillance are often taken without reference to good quality evidence. The aim of this study was to develop a treatment algorithm for patients with screen-detected polyp cancers. DESIGN: This national cohort study included all patients with a polyp cancer identified through the Scottish Bowel Screening Programme between 2000 and 2012. Multivariate regression analysis was used to assess the impact of clinical, endoscopic and pathological variables on the rate of adverse events (residual tumour in patients undergoing segmental resection or cancer-related death or disease recurrence in any patient). These data were used to develop a clinically relevant treatment algorithm. RESULTS: 485 patients with polyp cancers were included. 186/485 (38%) underwent segmental resection and residual tumour was identified in 41/186 (22%). The only factor associated with an increased risk of residual tumour in the bowel wall was incomplete excision of the original polyp (OR 5.61, p=0.001), while only lymphovascular invasion was associated with an increased risk of lymph node metastases (OR 5.95, p=0.002). When patients undergoing segmental resection or endoscopic surveillance were considered together, the risk of adverse events was significantly higher in patients with incomplete excision (OR 10.23, p<0.001) or lymphovascular invasion (OR 2.65, p=0.023). CONCLUSION: A policy of surveillance is adequate for the majority of patients with screen-detected colorectal polyp cancers. Consideration of segmental resection should be reserved for those with incomplete excision or evidence of lymphovascular invasion.
Subject(s)
Algorithms , Colonic Polyps/pathology , Colonic Polyps/surgery , Colorectal Neoplasms/pathology , Colorectal Neoplasms/surgery , Neoplasm Recurrence, Local/diagnosis , Watchful Waiting , Aged , Blood Vessels/pathology , Colectomy , Colonoscopy , Disease-Free Survival , Early Detection of Cancer , Evidence-Based Medicine , Female , Humans , Lymphatic Metastasis , Lymphatic Vessels/pathology , Male , Neoplasm Invasiveness , Neoplasm, Residual , Risk Factors , Scotland , Survival RateABSTRACT
Upper limb dominance is associated with increased limb volume, however there is a paucity of evidence if this is true for the lower limbs. This study investigated if there is a normative volume difference between the dominant and nondominant leg. Healthy volunteers between the ages of 18-40 years were recruited. Exclusion criteria included previous lower limb surgery, BMI >30, or pregnancy. An experienced lymphedema nurse specialist measured the circumference of each limb at 4 cm intervals from the malleolus to the groin. Measurements were used to calculate volume of each limb in milliliters. 100 (52 male, 48 female) participants met our inclusion criteria. 86% were right leg dominant and 14% left leg dominant. 93% demonstrated an average increased volume of 349 ml (4.5%) in the dominant leg which is statistically significant (p<0.001). Age, sports, and gender did not affect lower limb volumes. This is the first study to show a normative variance in leg volume in healthy individuals, with a greater volume in the dominant leg. This should be taken into consideration when managing and measuring outcomes for patients with conditions resulting in enlarged lower limbs.
