Curative Intent For Colorectal Cancer Research Articles

Postoperative inpatient exercise facilitates recovery after laparoscopic surgery in colorectal cancer patients: a randomized controlled trial

BackgroundEarly mobilization is an integral part of an enhanced recovery program after colorectal cancer surgery. The safety and efficacy of postoperative inpatient exercise are not well known. The primary objective was to determine the efficacy of a postoperative exercise program on postsurgical recovery of stage I–III colorectal cancer patients.MethodsWe randomly allocated participants to postoperative exercise or usual care (1:1 ratio). The postoperative exercise intervention consisted of 15 min of supervised exercise two times per day for the duration of their hospital stay. The primary outcome was the length of stay (LOS) at the tertiary care center. Secondary outcomes included patient-perceived readiness for hospital discharge, anthropometrics (e.g., muscle mass), and physical function (e.g., balance, strength).ResultsA total of 52 (83%) participants (mean [SD] age, 56.6 [8.9] years; 23 [44%] male) completed the trial. The median LOS was 6.0 days (interquartile range; IQR 5–7 days) in the exercise group and 6.5 days (IQR 6–7 days) in the usual-care group (P = 0.021). The exercise group met the targeted LOS 64% of the time, while 36% of the usual care group met the targeted LOS (colon cancer, 5 days; rectal cancer, 7 days). Participants in the exercise group felt greater readiness for discharge from the hospital than those in the usual care group (Adjusted group difference = 14.4; 95% CI, 6.2 to 22.6; P < 0.01). We observed a small but statistically significant increase in muscle mass in the exercise group compared to usual care (Adjusted group difference = 0.63 kg; 95% CI, 0.16 to 1.1; P = 0.03).ConclusionPostsurgical inpatient exercise may promote faster recovery and discharge after curative-intent colorectal cancer surgery.Trial registrationThe study was registered at WHO International Clinical Trials Registry Platform (ICTRP; URL http://apps.who.int/trialsearch); Trial number: KCT0003920.

Implementation of an organized colorectal cancer screening program through quantitative fecal immunochemical test followed by colonoscopy in an urban low-income community: Guidance and strategies

Fecal Immunochemical Test (FIT) followed by a colonoscopy is an efficacious strategy to improve the adenoma detection rate and Colorectal Cancer (CRC). There is no organized national screening program for CRC in Brazil. The aim of this research was to describe the implementation of an organized screening program for CRC through FIT followed by colonoscopy, in an urban low-income community of São Paulo city. The endpoints of the study were: FIT participation rate, FIT positivity rate, colonoscopy compliance rate, Positive Predictive Values (PPV) for adenoma and CRC, and the rate of complications. From May 2016 to October 2019, asymptomatic individuals, 50–75 years old, received a free kit to perform the FIT. Positive FIT (≥ 50 ng/mL) individuals were referred to colonoscopy. 10,057 individuals returned the stool sample for analysis, of which (98.2%) 9,881 were valid. Women represented 64.8% of the participants. 55.3% of individuals did not complete elementary school. Positive FIT was 7.8% (776/9881). The colonoscopy compliance rate was 68.9% (535/776). There were no major colonoscopy complications. Adenoma were detected in 63.2% (332/525) of individuals. Advanced adenomatous lesions were found in 31.4% (165/525). CRC was diagnosed in 5.9% (31/525), characterized as adenocarcinoma: in situ in 3.2% (1/31), intramucosal in 29% (9/31), and invasive in 67.7% (21/31). Endoscopic treatment with curative intent for CRC was performed in 45.2% (14/31) of the cases. Therefore, in an urban low-income community, an organized CRC screening using FIT followed by colonoscopy ensued a high participation rate, and high predictive positive value for both, adenoma and CRC.

Role Of Ovarian Metastases In Colorectal Cancer (ROMIC): a Dutch study protocol to evaluate the effect of prophylactic salpingo-oophorectomy in postmenopausal women

BackgroundThe mean incidence of ovarian metastases (OM) in patients with colorectal cancer (CRC) is 3.4%. The 5-year survival of these patients, even when operated with curative intent, is remarkably low. The lifetime risk of ovarian cancer is approximately 1.3%. Prophylactic salpingo-oophorectomy (PSO, or surgical removal of the ovaries and fallopian tubes) could reduce the number of CRC patients that develop OM after removal of the primary tumor, as well as preventing the occurrence of primary ovarian cancer. Recently, the care pathway for CRC has been changed in several hospitals in line with the updated Dutch guideline. The possibility of PSO is now discussed with postmenopausal CRC patients in these hospitals. The aims of the current study are firstly to estimate the incidence of OM and primary ovarian cancer in postmenopausal patients with CRC, and secondly to evaluate the effect of PSO in these patients.MethodsAn information bulletin and decision guide on this topic was implemented in several Dutch hospitals in 2020. Post-decision outcomes will be collected prospectively. The study population consists of postmenopausal (≥ 60 years of age) patients that are operated with curative intent for CRC. Based on their own preference, patients will be divided into two groups: those who choose to undergo PSO and those who do not. The main study parameters are the reduction in incidence of ovarian malignancies (metastatic or primary) following PSO, and the number needed to treat (NNT) by PSO to prevent one case of ovarian malignancy.DiscussionThis will be the first study to evaluate the effect of PSO in postmenopausal CRC patients that is facilitated by an altered CRC care pathway. The results of this study are expected to provide relevant information on whether PSO adds significant value to postmenopausal patients with CRC.Trial registrationInternational Clinical Trials Registry Platform, NL7870. Registered on 2019 July 12. URL of trial registry record: https://trialsearch.who.int/Trial2.aspx?TrialID=NL7870.Protocol version: 1.0, date 2021 June 8.

MicroRNA Expression Profiling Predicts Nodal Status and Disease Recurrence in Patients Treated with Curative Intent for Colorectal Cancer.

Simple SummaryDetermining the degree of nodal involvement provides key prognostic information in several malignancies, including colorectal cancer (CRC). Furthermore, predicting long-term outcomes in such cancers often proves challenging to the multidisciplinary team. Therefore, the purpose of this translational research study was to evaluate the role of mi(cro)RNAs as biomarkers used to predict nodal status and recurrence in patients being treated for CRC. This analysis involved the quantification of miRNA targets in 74 patients with CRC using real-time reverse transcriptase polymerase chain reaction. Aberrant expression of miR-21 and miR-135b correlated with increased metastatic disease in local lymph nodes following resection. Interestingly, increased expression of miR-195 displayed strong capabilities of predicting the time to disease recurrence. These results add to the growing evidence illustrating the value of using miRNA expression profiling to inform patient outcomes in cancer. These findings may be further validated in further studies as we attempt to personalise the management paradigm for prospective patients diagnosed with CRC.Background: Approximately one-third of colorectal cancer (CRC) patients will suffer recurrence. MiRNAs are small non-coding RNAs that play important roles in gene expression. We aimed to correlate miRNA expression with aggressive clinicopathological characteristics and survival outcomes in CRC. Methods: Tumour samples were extracted from 74 CRC patients. MiRNAs were quantified using real-time reverse transcriptase polymerase chain reaction. Descriptive statistics and Cox regression analyses were performed to correlate miRNA targets with clinicopathological and outcome data. Results: Aberrant miR-21 and miR-135b expression correlate with increased nodal stage (p = 0.039, p = 0.022). Using univariable Cox regression analyses, reduced miR-135b (β-coefficient −1.126, hazard ratio 0.324, standard error (SE) 0.4698, p = 0.017) and increased miR-195 (β-coefficient 1.442, hazard ratio 4.229, SE 0.446, p = 0.001) predicted time to disease recurrence. Survival regression trees analysis illustrated a relative cut-off of ≤0.488 for miR-195 and a relative cut-off of >−0.218 for miR-135b; both were associated with improved disease recurrence (p < 0.001, p = 0.015). Using multivariable analysis with all targets as predictors, miR-195 (β-coefficient 3.187, SE 1.419, p = 0.025) was the sole significant independent predictor of recurrence. Conclusion: MiR-195 has strong value in predicting time to recurrence in CRC patients. Additionally, miR-21 and miR-135b predict the degree nodal burden. Future studies may include these findings to personalize therapeutic and surgical decision making.

Risk factors for recurrence in colorectal cancer: a retrospective analysis in a regional Australian hospital.

Colorectal cancer is the third most commonly diagnosed malignancy in Australia. Up to a third of patients who have undergone surgery with curative intent for colorectal cancer will have a recurrence of disease leading to significant morbidity and mortality. Regional Australians have disproportionately worse outcomes. To identify factors associated with recurrence in colorectal cancer patients treated at a regional Australian hospital. This study is a retrospective cohort analysis. Consecutive patients who have undergone curative resection at a regional public and private hospital by three surgeons from a single surgical practice for either rectal cancer or colon cancer were included. Prognostic indicators of recurrence were examined via both univariate and multivariate time-to-event analyses. Three hundred nine patients were included with 43 recurrences. Thirty presented with distant metastases, seven presented with locoregional recurrence and six presented with locoregional as well as distant recurrence. In univariable analysis, higher rates of recurrence were associated with tumour type, higher AJCC summary stage, higher preoperative levels of CA19-9, perineural invasion, lymphovascular invasion, <12 nodes examined, positive lymph nodes and emergency surgery status. On multivariable analysis recurrence remained associated with tumours with a mucinous and/or signet cell component, positive nodes and <12 lymph nodes examined. A combination of patient and treatment factors are relevant in determining the risk of recurrence for stage I-III colorectal cancer. This study emphasises the importance of histology in determining risk, particularly the number of nodes examined. CEA 19-9 may also be a useful pre-operative predictor of recurrence.

Long-Term Outcomes After Colorectal Surgery in Patients with Ulcerative Colitis-Associated Colorectal Cancer Versus Sporadic Colorectal Cancer.

Ulcerative colitis is associated with a higher risk for developing colorectal cancer. It is unknown whether this translates into a worse prognosis when malignancy occurs. The goal of this study was to compare long-term outcomes between patients with ulcerative colitis-associated colorectal cancer and sporadic colorectal cancer. All patients who underwent surgery with curative intent for colorectal cancer in Denmark between January 2004 and June 2016 were included in the study. Patients diagnosed with ulcerative colitis were identified and matched 1:5 with patients with sporadic colorectal cancer using propensity score matching. The primary outcome was disease-free survival, with recurrence-free survival and all-cause mortality as secondary outcomes. In order to relate the results of the study to the existing literature, a systematic review with meta-analysis was conducted. A total of 1332 patients, 222 with ulcerative colitis and 1110 with sporadic colorectal cancer were included in the study. Disease-free survival was similar between the two groups with a hazards ratio (HR) 1.06 [95% confidence interval (CI) 0.85-1.32], as was recurrence-free survival HR 1.14 (95% CI 0.86-1.53) and all-cause mortality HR 1.15 (95% CI 0.89-1.48). The results of the systematic review identified seven other relevant studies. Meta-analysis showed a HR 1.67 (95% CI 0.61-4.56) for recurrence-free survival and HR 1.21 (95% CI 0.93-1.56) for all-cause mortality. There were no significant differences in long-term outcomes between ulcerative colitis-associated and sporadic colorectal cancer. However, the current results are limited by possible residual confounding and the meta-analysis by heterogeneity in confounding adjustment.

Anaemia and its impact on colorectal cancer patients: how can we better optimize surgical outcomes?

Anaemia is a common manifestation of colorectal cancer (CRC). However, appropriate workup prior to surgery and the effect of anaemia on outcomes have not been well defined. This study aimed to describe preoperative anaemia incidence, investigations performed, treatment and associated complications in a CRC surgical population at a single large tertiary institution in Australia. Patients who received surgery with curative intent for CRC between 2012 and 2017 were identified from a prospectively maintained database. Demographic and clinical outcome data were analysed. In total, 754 patients with CRC were included. Anaemia was found in 350 (46.4%) patients, of which 124 (35.4%) were microcytic, 20 (5.7%) were macrocytic and 206 (58.9%) were normocytic. Older patients were more likely to have anaemia (mean age 70.28 years, standard deviation (SD) 12.98 versus 64.74 years, SD 11.74). Only 89 patients (25.4%) were tested for iron deficiency, and of these, 76 (85.4%) were found to be iron deficient and 42 (47.7%) had low ferritin. Preoperative anaemia was associated with a higher incidence of postoperative complications (adjusted odds ratio (OR) 1.46, 95%, CI 1.04-2.05; P= 0.03) and a longer length of stay (LOS; average 1.8 days; 95% CI 0.3-3.3 days). A significant proportion of CRC patients had anaemia and the majority were normocytic. Only a small number of anaemic patients were tested for iron deficiency. Preoperative anaemia had an adverse effect on LOS and postoperative complications. The evaluation of anaemic patients is essential in CRC patients undergoing surgery.

Associations between blood cultures after surgery for colorectal cancer and long-term oncological outcomes.

Systemic inflammation following curative surgery for colorectal cancer may be associated with increased risk of recurrence. [Correction added on 29 November 2019, after first online publication: text amended for accuracy.] This study investigated whether a clinically suspected infection, for which blood cultures were sent within 30 days after surgery for colorectal cancer, was associated with long-term oncological outcomes. This register-based national cohort study included all Danish residents undergoing surgery with curative intent for colorectal cancer between January 2003 and December 2013. Patients who developed recurrence or died within 180 days after surgery were not included. Associations between blood cultures taken within 30 days after primary surgery and overall survival, disease-free survival and recurrence-free survival were analysed using Cox regression models adjusted for relevant clinical confounders, including demographic data, cancer stage, co-morbidity, blood transfusion, postoperative complications and adjuvant chemotherapy. The study included 21 349 patients, of whom 3390 (15·9 per cent) had blood cultures taken within 30 days after surgery. Median follow-up was 5·6 years. Patients who had blood cultures taken had an increased risk of all-cause mortality (hazard ratio (HR) 1·27, 95 per cent c.i. 1·20 to 1·35; P < 0·001), poorer disease-free survival (HR 1·22, 1·16 to 1·29; P < 0·001) and higher risk of recurrence (HR 1·15, 1·07 to 1·23; P < 0·001) than patients who did not have blood cultures taken. A clinically suspected infection requiring blood cultures within 30 days of surgery for colorectal cancer was associated with poorer oncological outcomes.

Preoperative immunonutrition in frail patients with colorectal cancer: an intervention to improve postoperative outcomes.

The aim of this study is to evaluate whether preoperative immunonutrition can shorten length of stay and improve postoperative outcomes in frail patients who are candidates for major oncologic colorectal surgery. A single center retrospective analysis of a prospectively collected database of frail patients, who underwent surgery with curative intent for colorectal cancer between January 2014 and December 2017, was performed. From March 2016, frail oncological patients undergoing major surgery were recommended to receive preoperative immunonutrition; their postoperative outcomes were compared to those of patients not treated with any preoperative nutritional support. Propensity score matching in a 1:1 ratio was used to balance patient characteristics. Overall, 175 patients were included in the study. Of 74 patients receiving immunonutrition, 65 were matched with the group not treated with immunonutrition (n = 101). Baseline characteristics were comparable after matching. Although differences in postoperative length of stay were nonsignificant (p = 0.38), patients who received immunonutrition showed a shorter gastrointestinal (GI) recovery time (3.00 [2.00-4.00] versus 4.00 [2.00-5.00], p = 0.04), a lower rate of situs site infections complications (0.31 [0.10, 0.94], p = 0.04) and less need of antibiotic treatment (0.19 [0.06, 0.64], p = 0.01). Preoperative immunonutrition was found to reduce both postoperative situs site infections and need of antibiotic treatment during the postoperative course. This study encourages the use of preoperative immune-enhancing nutrition as a part of multimodal prehabilitation programs in the management of frail colorectal cancer patients.

Stage-based variation in the impact of colon cancer surveillance.

3609 Background: Multiple meta-analyses have demonstrated that routine surveillance following curative intent colorectal cancer surgery improves overall survival. This benefit is largely driven by early detection and curative intent resection of oligometastatic disease. Intuitively, any surveillance benefit should be proportional to recurrence risk, leading some to question the value of surveillance for stage I patients where recurrence rates are low. However, the survival benefit of surveillance has not previously been reported by stage. Methods: We explored data from a multi-site cohort of colorectal cancer patients (pts) diagnosed from 1 January 2001 to 31 December 2016. Pts were followed according to standard protocols with a standardized comprehensive outcome data captured prospectively. Pts with a rectal primary or metastatic disease at presentation were excluded from the analysis. We examined the correlation of stage at diagnosis with tumor recurrence and subsequent outcomes. Results: Of 3608 colon cancer pts, 690 (19%) had stage 1, 1580 (44%) had stage 2, and 1338 (37%) had stage 3 disease. Median follow-up was 7.8 years. Stage at diagnosis impacted recurrence rate (4% stage I vs 12% stage II vs 28% stage III, p &lt; .0001) but not median time to recurrence. Recurrence patterns varied with stage (e.g. distant nodal disease 5% vs 7% vs 16%, p = .003; liver metastases 90% vs 53% vs 42%, p = 0.001). In pts with recurrence, resection of oligometastatic disease varied significantly by stage (58% vs 42% vs 30%, p &lt; .0001) as did post-resection 5 year survival (91% vs 66% vs 43%, p &lt; 0.001). In pts with recurrence treated with palliative intent, stage at diagnosis also impacted post-recurrence 5 year survival (11% vs 7% vs 5%, p &lt; 0.03). Conclusions: Colon cancer stage at diagnosis substantially impacts the proportion of pts able to undergo curative intent surgery for surveillance detected recurrent disease, potentially driven by stage specific metastatic patterns. Stage at diagnosis also has a significant impact on post-resection survival outcomes potentially driven by stage specific biology. Our data indicate a far greater survival impact of surveillance for stage I colon cancer than would be anticipated based on recurrence rate alone.

Oral versus intravenous fluoropyrimidines for colorectal cancer

Oral versus intravenous fluoropyrimidines for colorectal cancer

One-third of patients fail to return to work 1 year after surgery for colorectal cancer.

Achieving full recovery after colorectal cancer surgery means a return to normal physical and psychological health and to a normal social life. Recovery data focusses on time to discharge rather than longer term functionality including return to work (RTW). We aim to assess return to normal holistic function at 1 year after colorectal cancer surgery. Questionnaires were created and dispatched to 204 patients who had undergone surgery with curative intent for colorectal cancer, in 2011-2012, in a single teaching hospital. Response rate was 75 % (153/204), 82 % (129/157) for open surgery (OS) and 51 % (24/47) for laparoscopic surgery (LS). Median age was 68 (48-91) years for OS and 65 (36-84) for LS. Eighty-four per cent of patients felt 'ready' and 95 % had adequate pain control upon discharge (no difference between groups). LS reported earlier 'return to full fitness' (1-3 months) than OS (>6 months; Mann-Whitney U, p < 0.05). Recovery from LS was 'better than expected' compared to OS 'worse than expected' (Mann-Whitney U test, p < 0.05). Forty-nine patients were employed preoperatively and 61 % (n = 30) returned to work. RTW was more frequent after LS (Chi-square test, p < 0.05). Length of time to RTW was significantly less after LS [44 (6-84) days] than OS [71 (14-252) days] (t test, p < 0.05). Levels of self-employment were equal between groups. One-third of patients failed to RTW at 1 year post-surgery. Patients having LS returned to full fitness faster, felt recovery was shorter and returned to work earlier than OS. We must invest more in managing expectations and provide better post-discharge support to improve RTW.

Patterns of metachronous metastases after curative treatment of colorectal cancer

BackgroundThis study aimed to provide information on timing, anatomical location, and predictors for metachronous metastases of colorectal cancer based on a large consecutive series of non-selected patients. MethodsAll patients operated on with curative intent for colorectal cancer (TanyNanyM0) between 2003 and 2008 in the Dutch Eindhoven Cancer Registry were included (N=5671). By means of active follow-up by the Cancer Registry staff within ten hospitals, data on development of metastatic disease were collected. Median follow-up was 5.0 years. ResultsOf the 5671 colorectal cancer patients, 1042 (18%) were diagnosed with metachronous metastases. Most common affected sites were the liver (60%), lungs (39%), extra-regional lymph nodes (22%), and peritoneum (19%). 86% of all metastases was diagnosed within three years and the median time to diagnosis was 17 months (interquartile range 10–29 months). Male gender (HR=1.2, 95%CI 1.03–1.32), an advanced primary T-stage (T4 vs. T3 HR=1.6, 95%CI 1.32–1.90) and N-stage (N1 vs. N0 HR=2.8, 95%CI 2.42–3.30 and N2 vs. N0 HR=4.5, 95%CI 3.72–5.42), high-grade tumour differentiation (HR=1.4, 95%CI 1.17–1.62), and a positive (HR=2.1, 95%CI 1.68–2.71) and unknown (HR=1.7, 95%CI 1.34–2.22) resection margin were predictors for metachronous metastases. ConclusionsDifferent patterns of metastatic spread were observed for colon and rectal cancer patients and differences in time to diagnosis were found. Knowledge on these patterns and predictors for metachronous metastases may enhance tailor-made follow-up schemes leading to earlier detection of metastasized disease and increased curative treatment options.

Do the benefits outweigh the side effects of colorectal cancer surveillance? A systematic review

Most patients treated with curative intent for colorectal cancer (CRC) are included in a follow-up program involving periodic evaluations. The survival benefits of a follow-up program are well delineated, and previous meta-analyses have suggested an overall survival improvement of 5%-10% by intensive follow-up. However, in a recent randomized trial, there was no survival benefit when a minimal vs an intensive follow-up program was compared. Less is known about the potential side effects of follow-up. Well-known side effects of preventive programs are those of somatic complications caused by testing, negative psychological consequences of follow-up itself, and the downstream impact of false positive or false negative tests. Accordingly, the potential survival benefits of CRC follow-up must be weighed against these potential negatives. The present review compares the benefits and side effects of CRC follow-up, and we propose future areas for research.

Is early surveillance with CT scan necessary in patients with stage II/III colorectal cancer: A retrospective study

This analysis aims to evaluate the value of early surveillance within 6 months after resection for stage II/III colorectal cancer (CRC). Patients with stage II/III CRC who received surgery with curative intent for CRC were included. CT scans of the chest, abdomen, and pelvis performed within 6 months after surgery were evaluated. Among 150 patients included in the study, 10 patients (1 occurred in stage II disease and 9 occurred in stage III) were diagnosed as recurrence within 6 months after surgery. The proportion of patients diagnosed as recurrence was significantly higher in stage III disease than in stage II disease (P = 0.01). The likelihood of recurrence within 6 months was associated with the extent of lymph node metastases (r = 0.205, P = 0.012). Three patients with recurrent disease underwent salvage resection with curative intent. Early surveillance with CT scan within 6 months after curative resection may not be necessary for stage II disease. Although, the strategy may be helpful for stage III disease considering the high incidence of salvage surgery for recurrence disease, the early detection of recurrence could not be translated into survival benefit.

Abstract B14: Racial differences in colorectal cancer surveillance in South Carolina

Abstract Background and Study Rationale: More than one million people in the U.S. are living as colorectal cancer (CRC) survivors. Post-treatment risk of recurrence is a significant clinical problem and is compounded by evidence of low prevalence of surveillance, notably among African Americans (AA). In national samples (Rolnick et al. 2005; Lafata et al. 2008), AA are significantly less likely than European Americans (EA) to receive surveillance colonoscopy at guideline-recommended intervals, which likely contributes to disparities in CRC mortality rates. In 2007, U.S. age-adjusted CRC mortality rates were 19.5 for EA males, 29.1 for AA males, 13.7 for EA females, and 19.7 for AA females. The efficacy of surveillance colonoscopy has been well documented and it is the first-choice procedure for clinical surveillance after curative-intent CRC resection. CRC surveillance adherence is particularly important for AA, who tend to present at initial diagnosis with larger tumor size than EA, and who may be at greater risk of CRC recurrence. The purpose of this study was to examine whether the disparities in CRC surveillance seen nationally are present in South Carolina (SC). Methods: Statewide, population-based data from the SC Hospital Billing Data database for calendar year 2007 were used to examine whether racial differences were present in surveillance colonoscopy receipt after CRC resection. Unique IDs were used to track patients over time. ICD-9 diagnosis and procedure codes, race, and gender and were used to identify and categorize patients who received resection surgery and colonoscopy following resection at 1 year, 2 years, and 3 years post-resection. The Chi-square test was used to test for differences in receipt of surveillance colonoscopy based on race and gender by follow-up year. Results: Data from 1,273 (914 EA and 359 AA) patients diagnosed with Stage I–II CRC who received CRC resection in 2007 were evaluated. Significant racial differences in receipt of surveillance colonoscopy were seen. At 1 year post-resection, 25.6% of EA (n=234) and 18.1% of AA (n=65) had surveillance colonoscopy (p=0.005); at 2 years post-resection, 46.8% of EA (n=428) and 39.6% of AA (n=142) received surveillance colonoscopy (p=0.019); and at 3 years post-resection, 50.2% of EA (n=459) and 44.8% of AA (n=161) underwent surveillance (p=0.084). Among females, 25.0% of EA (n=114) compared with 18.2% of AA (n=37) received CRC surveillance at 1 year post-resection (p=0.056); at 2 years post-resection, 45.8% of EA (n=209) and 37.9% of AA (n=77) had surveillance colonoscopy (p=0.058); and at 3 years post-resection, 49.1% of EA females (n=224) compared with 43.3% of AA (n=88) underwent surveillance (p=0.171). Among males, the only statistically significant finding was at 1 year post-resection; 26.2% of EA (n=120) compared with 17.9% of AA (n=28) received CRC surveillance at 1 year post-resection (p=0.037); at 2 years post-resection, 47.8% of EA (n=219) and 41.7% of AA (n=65) had surveillance colonoscopy (p=0.183); and at 3 years post-resection, 51.3% of EA (n=235) compared with 46.8% of AA (n=73) underwent surveillance (p=0.330). Conclusions: Reflecting national data, surveillance colonoscopy rates are low in SC. Rates are substantially lower among AA than among EA and are lower for AA men than for EA men at 1 year post-resection, emphasizing the need for culturally appropriate surveillance plans. While a study limitation is that some patients may have received colonoscopies at sites that did not report their data to the registry, it is clear that not only are there racial and gender disparities in CRC surveillance colonoscopy but rates are sub-optimal for both EA and AA. These results will guide the development of targeted multi-level intervention strategies and messages to improve CRC surveillance adherence to optimize survivorship and improve quality of life. Citation Information: Cancer Prev Res 2011;4(10 Suppl):B14.

Abstract A55: Racial differences in colorectal cancer surveillance in South Carolina

Abstract Background and Study Rationale: More than one million people in the U.S. are living as colorectal cancer (CRC) survivors. Post-treatment risk of recurrence is a significant clinical problem and is compounded by evidence of low prevalence of surveillance, notably among African Americans (AA). In national samples (Rolnick et al. 2005; Lafata et al. 2008), AA are significantly less likely than European Americans (EA) to receive surveillance colonoscopy at guideline-recommended intervals, which likely contributes to disparities in CRC mortality rates. In 2007, U.S. age-adjusted CRC mortality rates were 19.5 for EA males, 29.1 for AA males, 13.7 for EA females, and 19.7 for AA females. The efficacy of surveillance colonoscopy has been well documented and it is the first-choice procedure for clinical surveillance after curative-intent CRC resection. CRC surveillance adherence is particularly important for AA, who tend to present at initial diagnosis with larger tumor size than EA, and who may be at greater risk of CRC recurrence. The purpose of this study was to examine whether the disparities in CRC surveillance seen nationally are present in South Carolina (SC). Methods: Statewide, population-based data from the SC Hospital Billing Data database for calendar year 2007 were used to examine whether racial differences were present in surveillance colonoscopy receipt after CRC resection. Unique IDs were used to track patients over time. ICD-9 diagnosis and procedure codes, race, and gender and were used to identify and categorize patients who received resection surgery and colonoscopy following resection at 1 year, 2 years, and 3 years post-resection. The Chi-square test was used to test for differences in receipt of surveillance colonoscopy based on race and gender by follow-up year. Results: Data from 1,273 (914 EA and 359 AA) patients diagnosed with Stage I–II CRC who received CRC resection in 2007 were evaluated. Significant racial differences in receipt of surveillance colonoscopy were seen. At 1 year post-resection, 25.6% of EA (n=234) and 18.1% of AA (n=65) had surveillance colonoscopy (p=0.005); at 2 years post-resection, 46.8% of EA (n=428) and 39.6% of AA (n=142) received surveillance colonoscopy (p=0.019); and at 3 years post-resection, 50.2% of EA (n=459) and 44.8% of AA (n=161) underwent surveillance (p=0.084). Among females, 25.0% of EA (n=114) compared with 18.2% of AA (n=37) received CRC surveillance at 1 year post-resection (p=0.056); at 2 years post-resection, 45.8% of EA (n=209) and 37.9% of AA (n=77) had surveillance colonoscopy (p=0.058); and at 3 years post-resection, 49.1% of EA females (n=224) compared with 43.3% of AA (n=88) underwent surveillance (p=0.171). Among males, the only statistically significant finding was at 1 year post-resection; 26.2% of EA (n=120) compared with 17.9% of AA (n=28) received CRC surveillance at 1 year post-resection (p=0.037); at 2 years post-resection, 47.8% of EA (n=219) and 41.7% of AA (n=65) had surveillance colonoscopy (p=0.183); and at 3 years post-resection, 51.3% of EA (n=235) compared with 46.8% of AA (n=73) underwent surveillance (p=0.330). Conclusions: Reflecting national data, surveillance colonoscopy rates are low in SC. Rates are substantially lower among AA than among EA and are lower for AA men than for EA men at 1 year post-resection, emphasizing the need for culturally appropriate surveillance plans. While a study limitation is that some patients may have received colonoscopies at sites that did not report their data to the registry, it is clear that not only are there racial and gender disparities in CRC surveillance colonoscopy but rates are suboptimal for both EA and AA. These results will guide the development of targeted multi-level intervention strategies and messages to improve CRC surveillance adherence to optimize survivorship and improve quality of life. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A55.

Postoperative infections are associated with adverse outcome after resection with curative intent for colorectal cancer

This study focused on the impact of post-operative infection on patient outcome after resection with curative intent for colorectal cancer. Postoperative surgical and medical complications have been implicated as a negative predictor of long-term outcome in various malignancies. We studied a population of 1083 patients who underwent resection with curative intent for colorectal cancer. These patients were divided into 2 groups based on the occurrence (65 patients, 6%) or absence (1018 patients, 94%) of postoperative complications due to infection. We investigated the demographic and clinicopathological features of each patient with and without postoperative infectious complications, as well as the impact of postoperative infection on long-term survival. Results showed that patients with postoperative infectious complications had diabetes mellitus more frequently and also had urgent surgery compared to those without infectious complications. In addition, patients with postoperative infectious complications had a significantly more unfavorable outcome compared with those without postoperative infection in cancer-specific, but not overall survival. Multivariate analysis demonstrated that age, rectal cancer and tumor stage correlated with overall survival, but not postoperative infectious complications. However, postoperative infections, as well as gender, were associated with the length of time until the patient succumbed from the recurrence of colorectal cancer after resection for curative intent. Thus, postoperative infectious complications are predictors of adverse clinical outcome in patients with colorectal cancer. However, further immunological study is necessary to confirm the biological significance of these findings.

Strict follow-up programme including CT and 18F-FDG-PET after curative surgery for colorectal cancer

The risk of local recurrence following curative surgery for colorectal cancer (CRC) is up to 50%. A rigorous follow-up program may increase survival. Guidelines on suitable methods for scheduled follow up examinations are needed. This study evaluates a strict follow-up program including carcinogenic embryonic antigen (CEA), chest X-ray, abdominal ultrasound (US), computed tomography (CT) and (18)F-FDG positron emission tomography (FDG-PET). A cohort of 132 patients, treated by surgery with curative intent for CRC, was included. Patients were followed prospectively with scheduled controls at 3, 6, 12 and 24 months after curative surgery. CEA, chest X-ray, US, CT and FDG-PET supplemented by clinical examination. The end-point was recurrence. Sensitivity and specificity was estimated 2 years after surgery. Of the 132 patients included in the study, 25 experienced recurrence, detected at scheduled controls (n = 18) and at intervals between them (n = 7). The results of CT and FDG-PET were correlated with recurrence. CT combined with FDG-PET had the highest specificity and sensitivity. A total of 72% of recurrences were detected at scheduled controls. The findings supported a strict follow-up program following curative surgery for colorectal cancer. FDG-PET combined with CT should be included in control programs.

Compliance, attitudes and barriers to post‐operative colorectal cancer follow‐up

Meta-analyses demonstrate that surveillance following curative-intent colorectal cancer (CRC) surgery can improve survival. Our multidisciplinary team adopted a stringent CRC follow-up (FU) guideline in 2000. The purpose of this study was to assess adherence and barriers to FU for CRC. Patients with primary CRC aged 19-75 years, treated with curative intent surgery from July 2000 to December 2002 were identified from a prospective database. Compliance with FU was assessed primarily by chart review. We also surveyed patients and providers to explore attitudes and barriers to surveillance adherence using tenets of the Health Belief Model. 96 patients met inclusion criteria and were appropriate for FU. Median FU was 34 months. Guideline targets were met for 70% of clinic visits; 49% of carcinoembryonic antigen (CEA) determinations; and 62% of abdominal imaging studies. Post-operative colonoscopy did not occur in 6/93 patients. Seventy per cent of health care providers and 55% of patients completed a survey. Access to testing and confusion about which provider orders investigations were identified as important barriers to FU. Patterns of CRC FU were widely variable despite implementation of a guideline. Despite patient and provider agreement with the principles of CRC FU, adoption was inhibited by confusion among multiple providers regarding investigation coordination.