Abstract
BackgroundThe decision to perform surgery for patients with T1 colorectal cancer hinges on the estimated risk of lymph node metastasis, residual tumour and risks of surgery. The aim of this observational study was to compare surgical outcomes for T1 colorectal cancer with those for more advanced colorectal cancer.MethodsThis was a population‐based cohort study of patients treated surgically for pT1–3 colorectal cancer between 2009 and 2016, using data from the Dutch ColoRectal Audit. Postoperative complications (overall, surgical, severe complications and mortality) were compared using multivariable logistic regression. A risk stratification table was developed based on factors independently associated with severe complications (reintervention and/or mortality) after elective surgery.ResultsOf 39 813 patients, 5170 had pT1 colorectal cancer. No statistically significant differences were observed between patients with pT1 and pT2–3 disease in the rate of severe complications (8·3 versus 9·5 per cent respectively; odds ratio (OR) 0·89, 95 per cent c.i. 0·80 to 1·01, P = 0·061), surgical complications (12·6 versus 13·5 per cent; OR 0·93, 0·84 to 1·02, P = 0·119) or mortality (1·7 versus 2·5 per cent; OR 0·94, 0·74 to 1·19, P = 0·604). Male sex, higher ASA grade, previous abdominal surgery, open approach and type of procedure were associated with a higher severe complication rate in patients with pT1 colorectal cancer.ConclusionElective bowel resection was associated with similar morbidity and mortality rates in patients with pT1 and those with pT2–3 colorectal carcinoma.
Highlights
The introduction of population-based colorectal carcinoma screening programmes aims to reduce mortality from colorectal cancer
Ileocaecal and transverse resections accounted for 0⋅6 and 2⋅1 per cent of operations respectively; these were recategorized as right colectomies
Women with ASA grade I–II who underwent sigmoid resection had a 5 per cent risk of severe complications and men with ASA grade III–IV treated with left colectomy had an 18⋅8 per cent risk (Fig. 4). This population-based cohort study demonstrates that patients undergoing elective bowel resections for pT1 colorectal cancer have similar risks for surgical complications, severe complications and mortality as those undergoing elective bowel resections for pT2–3 colorectal carcinoma
Summary
The introduction of population-based colorectal carcinoma screening programmes aims to reduce mortality from colorectal cancer. The decision to perform surgery for patients with T1 colorectal cancer hinges on the estimated risk of lymph node metastasis, residual tumour and risks of surgery. The aim of this observational study was to compare surgical outcomes for T1 colorectal cancer with those for more advanced colorectal cancer. A risk stratification table was developed based on factors independently associated with severe complications (reintervention and/or mortality) after elective surgery. Conclusion: Elective bowel resection was associated with similar morbidity and mortality rates in patients with pT1 and those with pT2–3 colorectal carcinoma
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