Surgical Resection Of Colorectal Cancer Research Articles

Trends in colorectal cancer surgical resection rates during the screening era: a retrospective study in Italy

BackgroundFaecal immunochemical test (FIT)-based screening is effective in reducing colorectal cancer (CRC) incidence, but its sensitivity for proximal lesions remains low.ObjectivesWe compared age-adjusted CRC surgical resection rates across anatomic sites...

Surgical resection of colorectal cancer

Surgical resection of colorectal cancer

Leucine-rich repeat-containing G protein-coupled receptor 5 expression in lymph node metastases of colorectal cancer: Clinicopathological insights and prognostic implications.

Leucine-rich repeat-containing G protein-coupled receptor 5 (LGR5), a significant cancer stem cell marker in colorectal cancer (CRC), lacks lymph node (LN)expression studies. In this study, we identified LGR5 expression by RNAscope, a highly sensitive RNA in situ method, and analyzed its association with clinicopathological characteristics. Tissue microarrays were generated from primary tumors (PTs) and LN metastases in paraffin-embedded blocks of 38 CRC surgical resection materials. LGR5 expression by RNAscope was evaluated by dividing the expression levels into negative and positive expression. In all but two cases of LNmetastasis, LGR5-positive dots were detected in tumor cells, and there was a wide range of LGR5-positive cells. More LGR5-positive dots were identified in the gland-forming region. Twenty-three cases were classified into a high LGR5-expression group, and 15 cases were classified into a low LGR5-expression group. In the high LGR5-expression group, the histological grade was lower than in the low LGR5-expression group (p = 0.0159), while necrosis was significantly more prevalent (p = 0.0326), and the tumor, node, metastasis stage was significantly lower (p = 0.0302). There was no association between LGR5 expression levels in LN metastases and LGR5 expression levels in PT tissue. LGR5 expression in LN metastases may influence prognosis. Further analysis may lead to new therapeutic strategies.

Preclinical evaluation of AGTR1-Targeting molecular probe for colorectal cancer imaging in orthotopic and liver metastasis mouse models

Despite advancements in colorectal cancer (CRC) treatment, the prognosis remains unfavorable for patients with distant liver metastasis. Fluorescence molecular imaging with specific probes is increasingly used to guide CRC surgical resection in real-time and treatment planning. Here, we demonstrate the targeted imaging capacity of an MPA-PEG4-N3-Ang II probe labeled with near-infrared (NIR) fluorescent dye targeting the angiotensin II (Ang II) type 1 receptor (AGTR1) that is significantly upregulated in CRC. MPA-PEG4-N3-Ang II was highly selective and specific to in vitro tumor cells and in vivo tumors in a mouse CRC xenograft model. The favorable ex vivo imaging and in vivo biodistribution of MPA-PEG4-N3-Ang II afforded tumor-specific accumulation with low background and >10 contrast tumor-to-colorectal values in multiple subcutaneous CRC models at 8 h following injection. Biodistribution analysis confirmed the probe's high uptake in HT29 and HCT116 orthotopic and liver metastatic models of CRC with signal-to-noise ratio (SNR) values of tumor-to-colorectal and -liver fluorescence of 5.8 ± 0.6, 5.3 ± 0.7, and 2.7 ± 0.5, 2.6 ± 0.5, respectively, enabling high-contrast intraoperative tumor visualization for surgical navigation. Given its rapid tumor targeting, precise tumor boundary delineation, durable tumor retention and docking study, MPA-PEG4-N3-Ang II is a promising high-contrast imaging agent for the clinical detection of CRC.

O156: Post-operative surveillance following curative resection of colorectal cancer in an elderly population

Abstract Introduction There are over 42,000 new cases of colorectal cancer in the UK each year with the highest incidence rates in those aged 85-89. Post-colorectal cancer surveillance aims to reduce cancer incidence and mortality, but its necessity and effectiveness remain debated especially in an elderly population. This study explores the relevance of computer tomography (CT) and colonoscopy surveillance in patients aged 75 and over who have undergone curative resection for colorectal cancer. Methods A retrospective analysis of prospectively collected data was conducted on patients aged 75 and over who had undergone surgical resection of colorectal cancer between November 2014 and August 2021. Data on demographics, treatment, survival, and surveillance were gathered from electronic patient records. The primary outcome was adherence to follow-up colonoscopy and CT-scan surveillance following surgery. Results A total of 417 patients underwent colorectal cancer surgery, with 334 included for analysis. Twelve-month CT surveillance showed normal results in 91.8% of cases, while 24-month CT surveillance demonstrated normal findings in 88.7%. Only 52.4% had colonoscopy follow-up, with 53.7% showing normal results, 42.3% demonstrated benign polyps, and 1.1% had histologically proven cancer. Reasons for not undergoing colonoscopy included patient preference (19.1%) and frailty (28.7%). Conclusion This study reinforces the notion that colonoscopy surveillance in patients over 75 may have limited benefits. In an aging population, benefits of surveillance in terms of early detection of recurrence must be balanced against the risks of harm from the procedure, availability of further management, cost-effectiveness, and patients’ preference.

Impact of preoperative white blood cell count on outcomes in different stage colorectal cancer patients undergoing surgical resection: a single-institution retrospective cohort study

PurposeTo explore the association between preoperative WBC count and the long-term survival outcomes and clinical outcomes in different stage patients who underwent surgical resection for colorectal cancer (CRC).Patients and methodsA cohort of 8121 Chinese patients who underwent surgical resection for CRC from January 1, 2008 to December 31, 2014 were enrolled as part of the retrospective cohort were retrospectively analyzed. Based on that the preoperative WBC optimal cut-off value was 7*109/L (7,000/µL), the high preoperative WBC group and the low preoperative WBC group was defined. Inverse probability of treatment weighting (IPTW) using the propensity score was used to reduce confounding. The impact of preoperative WBC count on overall survival (OS) and disease-free survival (DFS) was investigated using the Kaplan-Meier method and Univariate Cox proportional hazards models in different stage subgroup respectively.ResultsAfter IPTW, the clinical characters in the high preoperative WBC count group and the low preoperative WBC count group were balanced. Kaplan-Meier analysis showed that the 5-year OS rate were significantly lower in the high preoperative WBC count group overall, in stage II and IV. The 5-year DFS rate was significantly lower overall, in stage II and III in the high preoperative WBC count group. High preoperative WBC count was associated with poorer OS overall in stage II and stage IV.ConclusionsThis study suggests that preoperative WBC count is an independent risk factor for survival in patients undergoing colorectal surgery and may need to consider the stage of cancer when applied to predict long-term adverse outcome prognosis.

Causes of death in patients operated for colorectal cancer

BackgroundColorectal cancer remains the third leading cause of cancer-related mortality in the United States. This study evaluates the causes of death in patients operated on for colorectal cancer and their determinants. MethodsAn Instructional Review Board-approved database containing patients who underwent surgical resection for colorectal cancer from 2004 to 2018 (last followed up in December 2020) in a tertiary care institution. Data on the underlying cause of death was extracted from the Registry of Vital Records and Statistics in Massachusetts. ResultsA total of 576 deaths were recorded in the database, of which 290 (50.35%) patients died of colorectal cancer. Deaths from colorectal cancer gradually decreased over time, whereas deaths from other cancers increased, and deaths from cardiovascular diseases remained stable. Patients who died from colorectal cancer were younger, died earlier in the disease course, had fewer comorbidities, higher rates of stage IV disease, rectal cancer, neoadjuvant therapy, extramural vascular invasion, perineural invasion, R0 resection, and preserved mismatch repair protein status. On multivariate analysis, age (adjusted odds ratio for 10-year increase = 0.79, 95% confidence interval 0.65–0.95), American Society of Anesthesiologists score (adjusted odds ratio = 0.64, confidence interval 0.42–0.98), stage IV disease (adjusted odds ratio = 3.02, confidence interval 1.59–5.9), neoadjuvant therapy (adjusted odds ratio = 7.91, confidence interval 2.64–28.13), extramural vascular invasion (adjusted odds ratio = 2.3, confidence interval 1.36–3.91) & time from diagnosis to death (adjusted odds ratio = 0.76, confidence interval 0.68–0.83) predicted death due to colorectal cancer versus other causes, whereas tumor location, perineural invasion, R0 resection, and mismatch repair protein status did not. ConclusionThere is a declining trend of deaths from colorectal cancer, presumably reflecting advances in colorectal cancer management strategies and better screening over time. However, younger patients disproportionately contribute to death due to colorectal cancer and need aggressive screening and management strategies.

Clinicopathologic characteristics of patients with early-onset colorectal cancer.

74 Background: Although the incidence of colorectal cancer has been declining in the United States in recent years, the incidence of young patients under 50 years of age has been reported to be increasing by several percent per year. Various studies have been conducted to characterize early-onset colorectal cancer (EO-CRC); however, it has been unclear whether it is a different entity from late-onset colorectal cancer (LO-CRC). In this study, we evaluated the clinicopathologic characteristics of EO-CRC in Japan. Methods: This study included 1,336 patients who underwent surgical resection for colorectal cancer at Tokyo Metropolitan Komagome Hospital from January 2015 to December 2019. We performed genetic testing for patients with suspected Lynch syndrome after providing genetic counseling and obtaining informed consent. The study protocol was approved by the Institutional Review Board. Results: Of the 1,336 colorectal cancer patients, 117 (8.9%) had EO-CRC with a median age at the diagnosis of 44 (17–49) years. Tumors were located at right-sided colon in 23 patients and left-sided colorectum in 92 patients with EO-CRC, respectively. The clinical stage of the tumor was I in 19, II in 23, III in 50, and IV in 23 patients with EO-CRC, respectively. Histologically, differentiated type, undifferentiated type, and mucinous carcinoma were 106, 5, and 3 patients, respectively. KRAS mutation was detected in 25.0% and BRAF V600E was detected in 4.3% of patients with EO-CRC. In the microsatellite status, MSI-High was detected in 6 (5.1%) patients with EO-CRC, of whom 3 (2.6%) were diagnosed with Lynch syndrome by genetic testing. Causative genes were MLH1 in 2 patients and MSH2 in one patient. In hereditary tumors, 2 patients with familial adenomatous polyposis were included in addition to Lynch syndrome. On the other hand, 1,219 (91.2%) had LO-CRC with 34.5% of KRAS mutation and 6.4% of BRAFV600E. MSI-High was detected in 69(5.7%) patients with LO-CRC，of whom 5 (0.4%) were diagnosed with Lynch syndrome. Lynch syndrome was significantly more common in EO-CRC (p=0.026). Conclusions: The alterations of KRAS and BRAF tended to be more frequent in EO-CRC. The frequency of hereditary CRC was more frequent in EO-CRC than in LO-CRC.

Association of pathologic nodal status with minimal residual disease after neoadjuvant treatment and resection of locally advanced rectal cancer.

205 Background: Studies have shown that minimal residual disease (MRD) identified by detection of circulating tumor DNA (ctDNA) is associated with recurrence after surgical resection of colorectal cancer. Though multiple trials are evaluating the use of ctDNA to guide adjuvant therapy, data on the utility of ctDNA after neoadjuvant therapy is limited. In this study, we evaluated the associations between ctDNA and recurrence after neoadjuvant treatment and resection of rectal cancer (LARC). Methods: Consecutive patients with primary rectal cancer treated with neoadjuvant systemic therapy and/or chemoradiotherapy followed by resection between 12/2020-4/2023 were identified. Patients were tested for ctDNA via the MD Anderson INTERCEPT platform using a high-sensitivity patient informed assay. Patients with metastases or a first ctDNA test more than 3 months after resection were excluded. MRI-determined stage, extramural vascular invasion (mrEMVI), pelvic sidewall adenopathy (PSW), pathologic lymphovascular invasion (LVI), perineural invasion (PNI) and tumor regression grade (TRG) were collected. Associations between these factors and ctDNA status were analyzed with Fischer’s exact test. Recurrence free survival (RFS) was analyzed with the log-rank test. Results: Sixty-seven patients (3 treated with chemoradiotherapy alone, 15 with systemic therapy alone and 49 with total neoadjuvant therapy) were identified. Positive ctDNA was identified in 6 (8.9%) within 3 months after resection, all of whom received total neoadjuvant therapy, and 3/6 recurred within 12 months. Clinical T status (p=0.146), N status (p=0.842), mrEMVI (p=0.475) and PSW (p=0.318) were not associated with MRD. TRG was not associated with MRD (TRG0-1: 4% vs TRG2-3: 11.3%, p=0.547). Pathologic N status was associated with MRD (ypN0: 4.4% vs ypN+: 18%, p=0.049). MRD was associated with a median RFS of 3.2 months (HR 39, 95% CI: 4.1-380, p=0.0015). 1-year RFS was 98% for patients without MRD. Conclusions: Minimal residual disease after multi-modality treatment of LARC is associated with early metastatic recurrence. The patient informed MRD assay appears both sensitive and specific for detection of relapse. Advanced clinical stage and high-risk radiologic features were not associated with MRD, while post-treatment pathologic N status was. Given the high relapse rate for MRD+ patients, MRD detection after resection warrants additional investigation for metastases and/or enrollment on MRD treatment clinical trial. Methods to predict MRD prior to resection are urgently needed.

Efficacy and Safety of Extended Duration Postoperative Thromboprophylaxis with Low-Molecular-Weight-Heparin Among Subgroups of Patients Undergoing Surgical Resection of Colorectal Cancer: A Post-Hoc Analysis of the Periop-01 Trial

Background: Clinical practice guidelines suggest the use of extended duration of postoperative thromboprophylaxis to prevent venous thromboembolic (VTE) complications after any cancer-related major abdominal or pelvic surgeries. However, recent trials including patients undergoing surgical resection of colorectal cancer have reported relatively low rates of symptomatic VTE. Hence, the risk and benefits of extended postoperative thromboprophylaxis need to be carefully assessed in this patient population. We sought to determine the impact of extended duration thromboprophylaxis with low-molecular-weight-heparin on VTE and bleeding events among different subgroups of patients undergoing surgical resection of localized colorectal cancer. Methods: This is a pre-planned post-hoc analysis of the PERIOP-01 randomized controlled trial which compared extended (up to 6 weeks) to standard duration (in hospital only) of perioperative thromboprophylaxis with tinzaparin (4500 IU SC daily) in patients undergoing surgical resection of localized colorectal cancer. Subgroup analyses were performed based on different baseline characteristics. The primary efficacy and safety outcomes were objectively documented major VTE and combination of major bleeding (MB) and clinically relevant non-major bleeding (CRNMB) events, respectively. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated using the Cox proportional hazards model to compare the treatment effect accounting for clustering at study center level. Results: A total of 614 patients were randomized in the PERIOP-01 trial (307 in the extended and 307 in the standard duration thromboprophylaxis groups). Overall, the mean age of the participants was 61 years, 41% of them were women, and most patients were white (90%). Type of primary cancer was well-balanced with 311 patients having rectal cancer (51%), whereas 303 (49%) had primary colon cancer. During the study period, major VTE events occurred in 2% and 1% of the extended- and standard-duration prophylaxis groups, respectively (P=0.8). Combination of MB and CRNMB events occurred in 3% of each group. No specific characteristics were found to be associated with a decreased risk of major VTE among patients on extended duration thromboprophylaxis (Figure 1). Patients with colon cancer resection receiving extended thromboprophylaxis were at an increased risk of bleeding complication compared to patients with rectal cancer (HR 2.57, 95%CI 1.25-5.3) (Figure 1). Other characteristics that may be associated with an increased risk of bleeding among patient on extended thromboprophylaxis included age >= 75 (HR 2.37, 95%CI 0.47-11.98) and male sex (HR 2.13, 95%CI 0.2-23.17), although these characteristics were not statistically significant. Conclusions: In the PERIOP-01 trial, extended thromboprophylaxis didn't reduce the risk of major VTE in any subgroups of patients. On the other hand, extended duration of thromboprophylaxis may be associated with an increased bleeding risk among male, elderly patients, and those with colon cancer.

Post-operative Surveillance Following Curative Resection of Colorectal Cancer in the Elderly Population in the United Kingdom: An Observational Study.

Background Colorectal cancer most commonly affects the elderly population. Post-colorectal cancer surveillance aims to reduce cancer incidence and mortality, but its necessity and effectiveness are debated, especially in the elderly population. This study explores the relevance of computer tomography (CT) and colonoscopy surveillance in patients aged 75 and over who have undergone curative resection for colorectal cancer. Methods A retrospective analysis of prospectively collected data was conducted on patients aged 75 and over who had undergone surgical resection of colorectal cancer between November 2014 and August 2021. Data on demographics, treatment, survival, and surveillance were gathered from electronic patient records. The primary outcome was adherence to follow-up colonoscopy and CT-scan surveillance following surgery. Results A total of 417 patients underwent colorectal cancer surgery, with 334 included for analysis. The cohort had an average age of 81 years, with the majority receiving laparoscopic surgery and primary anastomosis. Twelve-month CT surveillance showed normal results in 281 patients (91.8%), while 24-month CT surveillance demonstrated normal findings in 244 patients (88.7%). Only 175 patients (52.4%) had colonoscopy follow-up, with 94 (53.7%) showing normal results, 74 (42.3%) demonstrating benign polyps, and two patients (1.1%) having histologically proven cancer. Reasons for not undergoing colonoscopy included declining invitations (30 patients, 19.1%) and being too frail (45 patients, 28.7%). Conclusion This study reinforces the notion that colonoscopy surveillance for patients over the age of 75 may have limited benefits. In an ageing population, the benefits of surveillance in terms of early detection of recurrence must be balanced against the risks of harm from the procedure, the availability of further management, cost-effectiveness, and patient preferences. An individualised approach should be adopted, potentially with colonoscopy surveillance only recommended in patients of higher risk (extramural venous invasion (EMVI)) and a low frailty score with a life expectancy over 10 years.

Inspecting the quality of care: a comparison of CUSUM methods for inter hospital performance

AbstractDuring the past 14 years, a clinical audit has been used in the Netherlands to provide hospitals with data on their performance in colorectal cancer care. Continuous feedback on the quality of care provided at each hospital is essential to improve patient outcomes. It is unclear which methods should be used to generate most informative output for the identification of potential quality issues. Our aim is to compare the commonly employed funnel plot with existing cumulative sum (CUSUM) methodology for the evaluation of postoperative survival and hospital stay outcomes of patients who underwent colorectal surgery in the Netherlands. Data from the Dutch ColoRectal Audit on 25367 patients in the Netherlands who underwent surgical resection for colorectal cancer in 71 hospitals between 2019 and 2021 is used to compare four methods for the detection of deviations in the quality of care. Two methods based on binary outcomes (funnel plot, binary CUSUM) and two CUSUM charts based on survival outcomes (BK-CUSUM and CGR-CUSUM) are considered. A novel approach for determining hospital specific control limits for CUSUM charts is proposed. The ability to detect deviations as well as the time until detection are compared for the four methods. Charts were constructed for the inspection of both postoperative survival and hospital stay. Methods using survival outcomes always yielded faster detection times compared to approaches employing binary outcomes. Detections between methods mostly coincided for postoperative survival. For hospital stay detections varied strongly, with methods based on survival outcomes signalling over half the hospitals. Further pros and cons as well as pitfalls of all methods under consideration are discussed. Methodology for the continuous inspection of the quality of care should be tailored to the specific outcome. Properly understanding how the mechanism of a control chart functions is crucial for the correct interpretation of results. This is particularly true for CUSUM charts, which require the choice of a parameter that greatly influences the results. When applying CUSUM charts, consideration of these issues is strongly recommended.

Effect of visceral fat area on the accuracy of preoperative CT-N staging of colorectal cancer

ObjectiveTo investigate the effect of visceral fat area (VFA) on the accuracy of preoperative CT-N staging of colorectal cancer. MethodsWe retrospectively reviewed the clinical and imaging data of 385 CRC patients who underwent surgical resection for colorectal cancer between January 2018 and July 2021. Preoperative CT-N staging and imaging features were determined independently by two radiologists. Using postoperative pathology as the gold standard, patients were divided into accurately and incorrectly staged groups, and clinical and imaging characteristics were compared between the two groups. VFA and subcutaneous fat area (SFA) at the L3 vertebral level, sex, age, BMI, tumor location, size, and tumor circumference ratio (TCR) were included. Logistic regression analysis was used to evaluate the independent factors influencing the accuracy of preoperative N staging of colorectal cancer. ResultsOf the 385 patients enrolled, 259 (67.27%) were in the preoperative N-stage accurate staging group, and 126 (32.73%) were in the incorrectly staged group. Univariate analysis showed that there were significant differences in BMI, tumor location, VFA, SFA, size and TCR between the two groups (P<0.05). Logistic regression analysis showed that VFA (95% CI: 1.277, 3.813; P=0.005) and TCR (95% CI: 1.649, 17.545; P=0.005) were independent factors affecting the accuracy of N staging. The optimal cutoff points for VFA and TCR in predicting incorrect staging were 110 cm2 and 0.675, respectively. ConclusionsColorectal cancer patients with lower VFA and higher TCR and preoperative CT-N staging had an increased risk for diagnostic errors.

Comparative detection of syndecan-2 methylation in preoperative and postoperative stool DNA in patients with colorectal cancer.

Early detection of colorectal cancer (CRC) is essential to reduce cancer-related morbidity and mortality. Stool DNA (sDNA) testing is an emerging method for early CRC detection. Syndecan-2 (SDC2) methylation is a potential biomarker for the sDNA testing. Aberrant DNA methylation is an early epigenetic event during tumorigenesis and can occur in the normal colonic mucosa during aging, which can compromise the sDNA test results. To determine whether methylated SDC2 in sDNA normalizes after surgical resection of CRC. In this prospective study, we enrolled 151 patients with CRC who underwent curative surgical resection between September 2016 and May 2020. Preoperative stool samples were collected from 123 patients and postoperative samples were collected from 122 patients. A total of 104 samples were collected from both preoperative and postoperative patients. Aberrant promoter methylation of SDC2 in sDNA was assessed using linear target enrichment quantitative methylation-specific real-time polymerase chain reaction. Clinicopathological parameters were analyzed using the results of SDC2 methylation. Detection rates of SDC2 methylation in the preoperative and postoperative stool samples were 88.6% and 19.7%, respectively. Large tumor size (3 cm, P = 0.019) and advanced T stage (T3-T4, P = 0.033) were positively associated with the detection rate of SDC2 methylation before surgery. Female sex was associated with false positives after surgery (P = 0.030). Cycle threshold (CT) values were significantly decreased postoperatively compared with preoperative values (P < 0.001). The postoperative negative conversion rate for preoperatively methylated SDC2 was 79.3% (73/92). Our results suggested that the SDC2 methylation test for sDNA has acceptable sensitivity and specificity. However, small size and early T stage tumors are associated with a low detection rate of SDC2 methylation. As the cycle threshold values significantly decreased after surgery, SDC2 methylation test for sDNA might have a diagnostic value for CRC.

Age-related variations in colon and rectal cancer: An analysis of the national cancer database

BackgroundCharacteristics of colorectal diseases may vary according to the patient’s age. By using a large national database, we assessed age-related differences in characteristics and treatments of colorectal cancer and to evaluate the influence of age on outcomes. MethodRetrospective cohort analysis of all patients who underwent surgical resection for colorectal cancer in the US National Cancer Database between 2005 and 2019. Patients were divided into 3 age groups: young age onset (<50 years), middle age group (50–79 years), and very old (≥80 years). Differences in tumor characteristics among groups were assessed. The main outcomes were clinical and treatment characteristics and short-term mortality. ResultsIn total, 662,102 patients with colon cancer and 114,460 with rectal cancer were included—36.1% of young patients with colon cancer presented with metastatic disease. Older patients underwent open surgery more often and received chemotherapy and radiation therapy less often than did the other 2 groups regarding disease stage. Very old patients, compared to middle-aged and young patients, had longer hospitalization and significantly higher rates of 30-day mortality after colon (7.6% vs 2.4% vs 0.7%; P < .001) and rectal (5.9% vs 1.3% vs 0.3%; P < .001) cancer surgery and higher 90-day mortality after colon (12.9% vs 4.6% vs 1.7% P < .001) and rectal (10.3% vs 2.6% vs 0.7%; P < .001) cancer surgery.Older patients had significantly shorter overall survival than the other 2 groups, regardless of pathologic stage, Charlson –Deyo comorbidity score, or tumor side. ConclusionSignificant age-related disparities in characteristics, treatments, and outcomes of colorectal cancer were found in this study. Recognizing these differences can be the first step toward reducing age-related treatment differences.

Assessment of Incidence of Metachronous Neoplasms after Surgical Resection of Colorectal Cancer

Abstract Background Cancer colon is the second most common cause of cancer in women and the third most common in men. Globally incidences vary 10-fold with highest rates in Australia, New Zealand, Europe and the US and lowest rates in Africa and South-Central Asia. However, in Egypt, CRC represent 4.2% of all cancers in male and 3.8% in females. Aim of the Work The aim of our study was to assess the incidence of Metachronous neoplasms after curative surgical resection of colorectal cancer and assess different risk factors for metachronous Cancer colon occurrence. Patients and Methods We enrolled 100 patients in this retrospective cohort study to predict incidence and risk factors of metachronous colorectal cancer (CRC) after 6 months of curative surgical resection of colorectal cancer. Results After 6 months of post-operative follow up, 90% of cases had no recurrence of CRC, 5% had polyps and did polypectomy, 5% had mass lesion. So patients were divided into two groups, Group (1) included patients with no recurrent CRC. Group (2) included patients with recurrent CRC. The incidence of metachronous CRC was 5% for mass and 5% for polyps in patients who underwent curative surgical resection of colorectal cancer. In both Univariate and multivariate Logistic regression analysis for the parameters affecting recurrent mass, DM was the only significant risk factor associated with the incidence of metachronous CRC with P values (0.043, 0.049) respectively. Conclusion The incidence of metachronous CRC in this study was 5% for mass and 5% for polyps in patients who underwent curative surgical resection of colorectal cancer. DM is a significant risk factor of metachronous CRC.

279 Quality and Prognostic Value of Colorectal Cancer Pathology Reports

Abstract Aim Comprehensive pathology reports are essential to inform clinical decision-making. An internal audit was conducted to determine whether the Trust Histopathology department fulfilled histopathological reporting standards for colorectal cancer (CRC) by the Royal College of Pathologists (RCPath). Methods Pathology reports for CRC surgical resection specimens between 2018-2021, were reviewed. Resections were from symptomatic (non-screening) patients, with no preoperative treatment. Benign or endoscopically obtained specimens, and non-primary CRC were excluded. Reports were reviewed for compliance with the CRC categories: I. median number of lymph nodes attained (≥12 per specimen) II. cases showing extramural venous spread (≥30%) III. cases showing peritoneal/serosal involvement (≥20%). Results 277 reports were included. Median lymph node yield was consistently &amp;gt;12, throughout. &amp;gt;30% of specimens demonstrated venous invasion between 2018-2020, however, 24% of specimens in 2021. Nearly all reports commented on the depth of venous invasion (e.g. ‘intramural’/‘extramural’) by 2021. &amp;gt;20% specimens demonstrated peritoneal involvement between 2018-2020, however this was 16% in 2021. Conclusions The quality of reports was high and consistent. There was overall compliance with the RCPath requirement. Results from 2021 may be affected by changes to pre-COVID CRC treatment pathways, with more patients presenting at a more advanced stage and receiving initial neoadjuvant treatment. As venous invasion is an independent prognostic indicator, documenting the extent of invasion is a quality assurance factor.

Managing the cancer backlog: a national population-based study of patient mobility, waiting times and 'spare capacity' for cancer surgery.

Waiting times for cancer treatments continue to increase in many countries. In this study we estimated potential 'spare surgical capacity' in the English NHS and identified regions more likely to have spare capacity based on patterns of patient mobility (the extent to which patients receive surgery at hospitals other than their nearest). We identified patients who had an elective breast or colorectal cancer surgical resection between January 2016 and December 2018. We estimated each hospital's 'maximum surgical capacity' as the maximum 6-month moving average of its surgical volume. 'Spare surgical capacity' was estimated as the difference between maximum surgical capacity and observed surgical volume. We assessed the association between spare surgical capacity and whether a hospital performed more or fewer procedures than expected due to patient mobility as well as the association between spare surgical capacity and whether or not waiting times targets for treatment were likely to be met. 100,585 and 49,445 patients underwent breast and colorectal cancer surgery respectively. 67 of 166 hospitals (40.4%) providing breast cancer surgery and 82 of 163 hospitals (50.3%) providing colorectal cancer surgery used less than 80% of their maximum surgical capacity. Hospitals with a 'net loss' of patients to hospitals further away had more potential spare capacity than hospitals with a 'net gain' of patients (p<0.001 for breast and p=0.01 for colorectal cancer). At the national level, we projected an annual potential spare capacity of 8389 breast cancer and 4262 colorectal cancer surgical procedures, approximately 25% of the volumes actually performed. Spare surgical capacity potentially exists in the present configuration of hospitals providing cancer surgery and requires regional allocation for efficient utilisation. National Institute for Health Research.

Comparison of changes in health-related quality of life between elderly and non-elderly patients undergoing elective surgery for colorectal cancer.

Elderly people are thought to be more likely than their non-elderly counterparts to experience a decline in activities of daily living (ADL) and quality of life (QOL) due to the onset and treatment of disease. In this study, we investigated whether there was an age-related difference in changes in health-related QOL indices after surgical resection of colorectal cancer (CRC). Patients who underwent elective surgery for primary CRC at our hospital between September 2017 and November 2021 were enrolled. Changes in QOL after surgery were evaluated after dividing the study population into a non-elderly (NE) group (younger than 75 years) and an elderly (E) group. A Short-Form 36-Item Health Survey was used as an index of QOL. The subscale and component summary scores before and 6 months after surgery were compared. Forty-seven patients were included in the E group and 166 patients were the NE group. The E group had significantly worse preoperative performance and physical status than the NE group. However, indices of physical function were not worsened after surgery in either group. In the NE group, there were significant decreases in role physical and role component summary scores and significant increases in general health, mental health, and mental component summary scores. In the E group, there were no significant changes in the subscale or component summary scores after surgery. Our study demonstrated elderly patient did not necessarily show a decline in QOL more than non-elderly patients after CRC surgery. Surgical resection for CRC should be considered even for elderly patients, while considering possible risk factors for worsening ADL and QOL.

The Enigma of Treating Colorectal Cancer and an Abdominal Aortic Aneurysm

As the average lifespan of individuals increases, malignancies and cardiovascular diseases are becoming a common cause of morbidity and mortality. The treatment of abdominal aortic aneurysms (AAAs) with concomitant diagnosis of colorectal cancer (CRC) is challenging. We aim to review the experience of a single tertiary institution in the management of patients with concurrent diagnosis of AAA and CRC hoping to glean information on how better to treat these patients. This is a retrospective review of all individuals treated between 2009 and 2022 at a large tertiary care center who had a documented diagnosis of CRC and AAA. A careful review of 102 patients resulted in a sample of 89 patients. Of the 89 patients in our cohort, 39 (43.8%) were diagnosed with CRC over 1 year before their AAA diagnosis. Fifteen (16.9%) patients were diagnosed with an AAA over 1 year before their CRC diagnosis and 35 (39.3%) were diagnosed concurrently with both CRC and AAA (Fig). In the concurrent subgroup, AAA was found on cancer staging workup CT scans, and we found the following in regard to their treatment: 12 (34.3%) individuals underwent CRC resection and surveillance of an AAA between 3 and 4 cm, 14 (40.0%) underwent CRC resection and surveillance of an AAA between 4 and 5 cm, and 3 (8.6%) had an AAA of over 5 cm and met criteria for repair; however, they had metastatic CRC and passed on hospice. There were no incidents of aneurysm rupture during surveillance. Ultimately, of the 35 individuals with concomitant AAA and CRC, 6 (17.1%) required treatment for both conditions—3 individuals had an endovascular aneurysm repair (EVAR) 4 to 6 months before CRC surgical resection, 2 had an EVAR after completing chemoradiation, and 1 individual had an EVAR 1.5 weeks after fecal diversion for obstructing CRC. In this group, there were no incidents of operative mortality. The treatment of both CRC and AAA has limited guidelines on how to proceed with the Society of Vascular Surgery level 2C recommendation for concomitant treatment. Our retrospective review of a single tertiary center identified 35 patients who were found to have an AAA during CRC workup. Although the majority had a small AAA that could be surveilled, of those who required repair, we found that EVAR was the sole approach. Further studies are needed to assess long-term outcomes with larger patient volumes from multiple institutions to recommend a definitive treatment algorithm.