Abstract
PurposeMany apparent differences exist in aetiology, genetics, anatomy and treatment response between colon cancer (CC) and rectal cancer (RC). This study examines the differences in patient characteristics, prevalence of complications and their effect on short-term survival, long-term survival and the rate of recurrence between RC and CC.MethodsFor all stage II–III CC and RC patients who underwent resection with curative intent (2006–2008) in five hospitals in the Netherlands, occurrence of complications, crude survival, relative survival and recurrence rates were compared.ResultsA total of 767 CC and 272 RC patients underwent resection. Significant differences were found for age, gender, emergency surgery, T-stage and grade. CC patients experienced fewer complications compared to RC (p = 0.019), but CC patients had worse short-term mortality rates (1.5 versus 6.7 % for 30-day mortality, p = 0.001 and 5.2 versus 9.5 % for 90-day mortality, p = 0.032). The adjusted HR (overall survival) for CC patients with complications was 1.57 (1.23–2.01; p < 0.001) as compared to patients without complications; for RC, the HR was 1.79 (1.12–2.87; p = 0.015). Relative survival analyses showed high excess mortality in the first months after surgery and a sustained, prolonged negative effect on both CC and RC. Complications were associated with a higher recurrence rate for both CC and RC; adjusted analyses showed a trend towards a significant association.ConclusionLarge differences exist in patient characteristics and clinical outcomes between CC and RC. CC patients have a significantly higher short-term mortality compared to RC patients due to a more severe effect of complications.
Highlights
Beart et al (1983) and Bufill et al (1990) were among the first to show clinical and morphological differences between colon cancer (CC) and rectal cancer (RC) over two decades ago
CC patients have a significantly higher short-term mortality compared to RC patients due to a more severe effect of complications
Between 2006 and 2008, 767 CC patients and 272 RC patients with stage I, II and III disease were operated with curative intent
Summary
Beart et al (1983) and Bufill et al (1990) were among the first to show clinical and morphological differences between colon cancer (CC) and rectal cancer (RC) over two decades ago. Many studies have since supported this Btwo types of CRC’s^ hypothesis, resulting in a more definitive separation of the colorectal cancer (CRC) group for scientific research and treatment. Many clinical consequences are still not fully understood [1]. Accumulating evidence suggests etiological differences between CC and RC. Various studies indicate that high body mass index, low physical activity and dietary parameters such as high intake of beef, pork or lamb, processed meat and alcohol are risk factors for CC but not for RC [2,3,4]. The prevalence of genetic mutations or mutation patterns and hereditary cancer types seem to vary between CC and RC [2].
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