The value of routine histopathological examination after haemorrhoidectomy in patients at low and high risk of anal squamous intraepithelial lesions and cancer

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Colorectal Disease Pub Date : 2025-03-17 DOI:10.1111/codi.70056

Panuwat Pornkul, Guy Lampe, Renae Bertucci, Shehan Wickramasinghe, Kerenaftali Klein, Chrispen Mushaya, Shinichiro Sakata

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Abstract

Aim

Routine histopathological evaluation of haemorrhoidectomy specimens is not ubiquitous amongst surgeons as its utility is debatable. This is the first study to assess the detection rate of anal squamous intraepithelial lesions (aSIL) and anal squamous cell carcinoma (aSCC) in low- and high-risk patients.

Method

This 9-year retrospective study assessed electronic medical records of all patients who underwent excisional haemorrhoidectomy within an Australian tertiary referral hospital. Patients with sinister clinical examination findings were excluded from the study. Data collected included patient demographics, pertinent history, relevant risk factors, histopathology reports and digital rectal examination findings. Cost–benefit analysis of routine pathology submission and a city-wide survey of surgeons to ascertain current practices were also undertaken.

Results

The overall prevalence of incidental aSIL and aSCC was 27 (8.1%); 19 patients (5.7%) had low-grade squamous intraepithelial lesions (LSILs), seven (2.1%) had high-grade squamous intraepithelial lesions (HSILs) and one patient (0.3%) had aSCC. More than three out of four were detected in low-risk patients, with most cases being LSIL. Comparing low-risk and high-risk patients, the observed incidental detection rate of aSIL and aSCC was 6.8% (95% CI 4.49–10.17) and 23.1% (95% CI 11.03–52.05), respectively. Multivariate logistic regression showed a large, significant association between high-risk risk factors and detecting aSIL and aSCC (OR 3.76, 95% CI 1.32–10.68, P = 0.013). A city-wide survey of surgeons demonstrated that 28.6% do not request routine histopathological evaluation and 64.3% thought that the prevalence of sinister incidental pathology in haemorrhoids was 1% or less. The total cost of conducting routine histopathological evaluation per patient was $96.80 AUD ($59.20 EUR, $65.30 USD).

Conclusion

Given the non-negligible incidental detection rate of aSIL and aSCC in both low-risk and high-risk patients, coupled with the cost-effectiveness of histopathological examination, this study suggests that routine histopathological examination should not be restricted solely to high-risk patients. Further study of the benefit of surveillance following clinical detection in low- and high-risk patients is needed.

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来源期刊

Colorectal Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

11.80%

发文量

406

审稿时长

1.5 months

期刊介绍： Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate. Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases. Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies. Note that the journal does not usually accept paediatric surgical papers.