One-year excess mortality and treatment in surgically treated patients with colorectal cancer: A EURECCA European comparison

Renu R Bahadoer,Esther Bastiaannet,Yvette H.M Claassen,Marianne Van Der Mark,Elizabeth Van Eycken,Julie Verbeeck,Marianne G Guren,Hartwig Kørner,Anna Martling,Robert Johansson,Cornelis J.H Van De Velde,Jan Willem T Dekker

doi:10.1016/j.ejso.2021.01.011

Abstract

BackgroundMortality in the first postoperative year represents an accurate reflection of the perioperative risk after colorectal cancer surgery. This research compares one-year mortality after surgery divided into three age-categories (18-64, 65-74, ≥75 years), focusing on time trends and comparing treatment strategies. MaterialPopulation-based data of all patients diagnosed and treated surgically for stage I-III primary colorectal cancer from 2007 to 2016, were collected from Belgium, the Netherlands, Norway, and Sweden. Stratified for age-category and stage, treatment was evaluated, and 30-day, one-year and one-year excess mortality were calculated for colon and rectal cancer separately. Results were evaluated over two-year time periods. ResultsData of 206,024 patients were analysed. Postoperative 30-day and one-year mortality reduced significantly over time in all countries and age-categories. Within the oldest age category, in 2015–2016, one-year excess mortality varied from 9% in Belgium to 4% in Sweden for colon cancer and, from 9% in Belgium to 3% in the other countries for rectal cancer. With increasing age, patients were less likely to receive additional therapy besides surgery. In Belgium, colon cancer patients were more often treated with adjuvant chemotherapy (p < 0.001). For neoadjuvant treatment of rectal cancer, patients in Belgium and Norway were mostly treated with chemoradiotherapy. In the Netherlands and Sweden, radiotherapy alone was preferred (p < 0.001). ConclusionsDespite improvement over time in all countries and age-categories, substantial variation exists in one-year postoperative mortality. Differences in one-year excess postoperative mortality could be due to differences in treatment strategies, highlighting the consequences of under- and over-treatment on cancer survival.

Highlights

Colorectal cancer is the third most common cancer in men and the second most commonly occurring cancer in women. [1] other treatment options are being investigated [2], surgery continues to play an essential role in the treatment of colorectal cancer
An earlier study by Dekker et al revealed that the excess mortality in the first postoperative year after colorectal cancer surgery is a more accurate reflection of the postoperative risk, in comparison with the 30-day mortality
The surgical treatment rate of all patients 18 years diagnosed with stage I-III colorectal cancer and reliable follow-up between 2007 and 2016 varied from 64.3% in Belgium and Norway to 66.1% in Sweden and 66.9% in the Netherlands

Summary

Introduction

Colorectal cancer is the third most common cancer in men and the second most commonly occurring cancer in women. [1] other treatment options are being investigated [2], surgery continues to play an essential role in the treatment of colorectal cancer. Using populationbased data of four European countries, Belgium, the Netherlands, Norway, and Sweden, the current research aims to make an international comparison of the one-year mortality after surgery and compare time trends and treatment of colorectal patients in three age categories. Material: Population-based data of all patients diagnosed and treated surgically for stage I-III primary colorectal cancer from 2007 to 2016, were collected from Belgium, the Netherlands, Norway, and Sweden. Stratified for age-category and stage, treatment was evaluated, and 30-day, one-year and one-year excess mortality were calculated for colon and rectal cancer separately. Within the oldest age category, in 2015e2016, one-year excess mortality varied from 9% in Belgium to 4% in Sweden for colon cancer and, from 9% in Belgium to 3% in the other countries for rectal cancer. Differences in one-year excess postoperative mortality could be due to differences in treatment strategies, highlighting the consequences of under- and overtreatment on cancer survival

Methods

Results

Discussion

Conclusion