Is histopathological analysis necessary in patients undergoing sigmoidectomy for diverticular disease? A retrospective study.

in Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland by Antonietta Petrusic, Francesco Mongelli, Flaminia Sabbatini, Dimitri Christoforidis, Ramon Pini, Elisabetta Merlo, Sotirios Georgios Popeskou, Davide La Regina, Fabiano Iaquinandi

TLDR

  • The study shows that routine histopathological examination may not be necessary for patients undergoing sigmoidectomy for diverticular disease after preoperative colonoscopy, as the results are highly concordant.
  • The study identified only one high-risk patient with a clinically significant finding, suggesting that histopathological examination may only be justified for patients at high risk for complications.

Abstract

The purpose of this study was to assess the utility of routine histopathological examination in patients undergoing elective sigmoidectomy for diverticular disease after full colonoscopy 1 year prior to surgery. We retrospectively analysed medical records of all patients undergoing sigmoidectomy for diverticular disease with a documented colonoscopy within 1 year before surgery from January 2013 to December 2023. We collected preoperative, intraoperative and postoperative data of all patients. The primary endpoint was the percentage of patients with an unexpectedly abnormal histopathological report compared to colonoscopy. During the study period, 207 patients undergoing sigmoidectomy for diverticular disease were included. Mean age was 62.7 ± 13.0 years and 97 (46.9%) patients were men. In eight (3.9%) cases an unexpected finding was noted on the histopathological examination: five (2.4%) of them were hyperplastic polyps with no dysplasia and no clinical relevance, two (1.0%) were polyps with low-grade dysplasia and in one case (0.5%) a diffuse large B-cell lymphoma was present in a patient with history of lymphoma treated in the past 10 years. The Goodman and Kruskal's G index was 0.953 (95% lower limit of 0.913), which indicated high concordance between the colonoscopy and the definitive histopathological examination. In our series, the preoperative colonoscopy reliably predicted the result of the histopathological specimen findings in patients undergoing sigmoidectomy for diverticular disease. Only one (0.5%) high-risk patient had an unexpected clinically significant finding. Therefore, routine histopathological examination may not be justified for all patients.

Overview

  • The study aimed to evaluate the utility of routine histopathological examination in patients undergoing elective sigmoidectomy for diverticular disease after full colonoscopy 1 year prior to surgery.
  • The study retrospectively analyzed medical records of patients undergoing sigmoidectomy for diverticular disease with documented colonoscopy within 1 year before surgery from January 2013 to December 2023.
  • The primary endpoint was the percentage of patients with unexpectedly abnormal histopathological reports compared to colonoscopy.

Comparative Analysis & Findings

  • The study found that 3.9% of patients had unexpectedly abnormal histopathological reports, with 2.4% being hyperplastic polyps with no dysplasia and no clinical relevance.
  • In 1% of cases, polyps with low-grade dysplasia were found, and in one case, a diffuse large B-cell lymphoma was present in a patient with a history of lymphoma.
  • The study found high concordance between colonoscopy and histopathological examination, with a Goodman and Kruskal's G index of 0.953.

Implications and Future Directions

  • The study suggests that routine histopathological examination may not be justified for all patients undergoing sigmoidectomy for diverticular disease after preoperative colonoscopy.
  • Future studies should focus on identifying high-risk patients who would benefit from histopathological examination, such as those with a history of lymphoma.
  • The study highlights the importance of accurate preoperative colonoscopy in reducing the need for unnecessary histopathological examination.
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