Introduction Due to the varying risks of residual disease that have been reported after removal of malignant polyps, clinicians rely on clinical practice guidelines (CPGs) to inform decision-making. This study qualitatively and quantitatively compared the internationally published guidelines on the management of malignant colorectal polyps.
Method A systematic literature search was undertaken to identify malignant colorectal polyp CPGs. Quantitative comparison was based on the Appraisal of Guidelines Research and Evaluation (AGREE II), a validated CPG appraisal tool which assesses 6 domains: scope and purpose; stakeholder involvement; rigour of development; clarity and presentation; applicability; and editorial independence. Histopathological risk factor assessment and treatment recommendations were further analysed for supporting levels of evidence and scientific agreement.
Results Eleven International malignant colorectal polyp guidance documents were included. The AGREE assessment demonstrated significant variation in all quality domains across the CPGs. The scope and purpose domain showed the highest level of quality (median: 91%, interquartile range (IQR): 86–97%). The Applicability domain showed the lowest level of quality (median: 43%, IQR: 35–55%). Risk was attributed dichotomously (low/high risk) to malignant polyps in 8/11 CPGs and in a graded fashion in the remainder. Importantly, there were disagreements regarding which histopathological findings carried risk. Significant variation was found for degree of risk between CPGs for resection margins, tumour budding and depth of invasion. No CPG was able to provide a comprehensive analysis when multiple histopathogical risk factors are present in an MCP. The indications for local excision also demonstrated considerable variation.
Conclusion There is variation in evidence interpretation and recommendations between widely used malignant colorectal polyp CPGs. Improvements in the underlying evidence base, particularly defining accurate probabilities of residual disease in the presence of multiple histopathological risk factors, are required to allow clinicians to provide personalised care to this complex patient group.
Disclosure of interest None Declared.
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