ObjectivesLarge disparities in colorectal cancer (CRC) management and survival have been observed across Europe. Despite recent increases, the survival deficit of Estonian patients with CRC persists, particularly for rectal cancer. The aim of this study was to examine diagnostic, staging and treatment patterns of CRC in Estonia, comparing clinical data from 1997 and 2011.DesignNationwide population-based retrospective study.SettingEstonia.ParticipantsAll incident cases of colon and rectal cancer diagnosed in 1997 and 2011 identified from the Estonian Cancer Registry. Clinical data gathered from medical records.Outcome measuresDifferences in diagnostic, staging and treatment patterns; 5-year relative survival ratios.ResultsThe number of colon cancer cases was 337 in 1997 and 498 in 2011; for rectal cancer, the respective numbers were 209 and 349. From 1997 to 2011, large increases were seen in the use of colonoscopy and lung and liver imaging. Radical resection rate increased from 48% to 59%, but emergency surgeries showed a rise from 18% to 26% in colon and from 7% to 14% in rectal cancer. The proportion of radically operated patients with ≥12 lymph nodes examined pathologically increased from 2% to 58% in colon cancer and from 2% to 50% in rectal cancer. The use of neoadjuvant radiotherapy increased from 6% to 39% among stage II and from 20% to 50% among patients with stage III rectal cancer. The use of adjuvant chemotherapy in stage III colon cancer increased from 42% to 63%. The 5-year RSR increased from 50% to 58% in colon cancer and from 37% to 64% in patients with rectal cancer.ConclusionsMajor improvements were seen in the diagnostics, staging and treatment of CRC in Estonia contributing to better outcomes. Increase in emergency surgeries highlights possible shortcomings in timely diagnosis and treatment.

5FU-related MI, and one patient with bowel perforation. No treatment related deaths occurred. Patients older than 70 had a lower completion rate (28.5% vs. 77%, p ¼ 0.016), higher admission rate (85% vs. 61%, p ¼ 0.228) but similar grade 3/4 toxicity rate (57% vs. 61%, p ¼ 0.832) compared to younger counterparts. Compared to AIO -FLOT4 trial, our patients had higher rates of: discontinuation (33.3% vs. 6%), dose reductions (24% vs. 6%) and serious adverse events (70% vs. 41%). The commonest grade3/4 toxicity was neutropenia in both cohorts, but was less frequent in our institution (30% vs. 52%) probably due to primary GCSF prophylaxis. Grade 3/4 nausea/ vomiting was commonest in the AOI-FLOT 4 cohort (12% vs. 6%), while grade3/4 diarrhoea was more frequent in our institution (12% vs. 7%). Fatigue grade 3/4 was commonest in our cohort (12% vs. 9%). No grade 3/4 cases of neurotoxicity were reported in our cohort, compared with the AIO-FLOT4 (8%). Conclusion: Neoadjuvant FLOT for resectable GOA was less tolerable and more toxic in our cohort, with higher rate of early treatment discontinuations, dose reductions, serious adverse events. The above results demonstrate that every day clinical practice often differs from trial results and underscore the importance of reporting real world experience data, especially regarding safety issues.