Abstract
BackgroundSynchronous colorectal cancer (CRC) has been associated with higher postoperative morbidity and mortality rates compared to solitary CRC. The influence of improved CRC care and introduction of screening on these outcomes remains unknown. This study aimed to evaluate time trends in incidence, population characteristics, and short-term outcomes of synchronous CRC patients at the population level over a 10-year time period. MethodsData of all patients that underwent resection for primary CRC were extracted from the Dutch ColoRectal Audit (2010–2019). Analyses were stratified for solitary and synchronous colon and rectal cancer. Multilevel logistic regression analyses were used to determine factors associated with pathological and surgical outcomes. ResultsAmong 100,474 patients, 3.1% underwent surgery for synchronous CRC. A screening-related decrease for surgically treated left-sided solitary and synchronous colon cancer and a temporary increase for exclusively right-sided colon cancer were observed. Synchronous CRC patients had higher rates of complicated postoperative course, failure to rescue, and mortality. Bilateral synchronous colon cancer was more often treated with subtotal colectomy (25.4%) and demonstrated higher rates of surgical complications, reinterventions, prolonged hospital stay, and mortality than other synchronous tumor locations. DiscussionNational bowel screening resulted in contradictory effects on surgical resections for synchronous CRCs depending on sidedness. Bilateral synchronous colon cancer required more often extended resection resulting in significantly worse outcomes than other synchronous tumor locations. Identification of low volume, high complex CRC subpopulations is relevant for individualized care and has implications for case-mix correction and benchmarking in clinical auditing.
Highlights
Synchronous colorectal cancer (CRC) is defined as the occurrence of more than one colorectal tumor at the same time or within 6 months of the initial diagnosis.[1]
To evaluate the time trend in CRC resections, the absolute numbers of CRC resections per tumor location were calculated for each year
Time trends for incomplete resection margin rates, complicated course, failure to rescue, and mortality after colon and rectal cancer surgery were analyzed for each year
Summary
Synchronous colorectal cancer (CRC) is defined as the occurrence of more than one colorectal tumor at the same time or within 6 months of the initial diagnosis.[1]. In 2014, the national bowel cancer screening was introduced in the Netherlands, which has resulted in a shift towards more early-stage CRC diagnosis.[12] Studies have indicated that this has led to a more extensive preoperative workup,[13,14,15] a different surgical approach,[16, 17] and lower postoperative morbidity and mortality rate.[12] These studies often excluded synchronous CRC, while especially those patients might benefit from detection at an early stage, thereby potentially limiting. This study aimed to evaluate time trends in incidence, population characteristics, and short-term outcomes of synchronous CRC patients at the population level over a 10-year time period
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