A 10-Year Evaluation of Short-Term Outcomes After Synchronous Colorectal Cancer Surgery: a Dutch Population-Based Study

Abstract

Background Synchronous colorectal cancer (CRC) has been associated with higher postoperative morbidity and mortality rates compared to solitary CRC. The influence of improved CRC care and introduction of screening on these outcomes remains unknown. This study aimed to evaluate time trends in incidence, population characteristics, and short-term outcomes of synchronous CRC patients at the population level over a 10-year time period. Methods Data of all patients that underwent resection for primary CRC were extracted from the Dutch ColoRectal Audit (2010–2019). Analyses were stratified for solitary and synchronous colon and rectal cancer. Multilevel logistic regression analyses were used to determine factors associated with pathological and surgical outcomes. Results Among 100,474 patients, 3.1% underwent surgery for synchronous CRC. A screening-related decrease for surgically treated left-sided solitary and synchronous colon cancer and a temporary increase for exclusively right-sided colon cancer were observed. Synchronous CRC patients had higher rates of complicated postoperative course, failure to rescue, and mortality. Bilateral synchronous colon cancer was more often treated with subtotal colectomy (25.4%) and demonstrated higher rates of surgical complications, reinterventions, prolonged hospital stay, and mortality than other synchronous tumor locations. Discussion National bowel screening resulted in contradictory effects on surgical resections for synchronous CRCs depending on sidedness. Bilateral synchronous colon cancer required more often extended resection resulting in significantly worse outcomes than other synchronous tumor locations. Identification of low volume, high complex CRC subpopulations is relevant for individualized care and has implications for case-mix correction and benchmarking in clinical auditing.

Surveillance Colonoscopies of Synchronous Colorectal Cancer: What Should We Do?

“…Studies have shown that some tumor morphology is more common in patients with synchronous tumors. 2 , 16 , 17 Index tumors of synchronous cases were more frequently moderately differentiated, mucinous adenocarcinoma, more deeply penetrated, and more often ulcerated, while concurrent lesions were less advanced. 18 Our results reproduced Oya et al’s 18 report.…”

“…For SCRC that is distributed in multiple segments, the required extent of the procedure for tumors has remained controversial in the past decades. 17 , 19 Existing research demonstrated that there is no benefit in the survival of subtotal colectomy; therefore, segmental resection should be performed whenever possible. 20 In our study, most patients underwent multiple segment resection or extended resection, consistent with the previous studies.…”

“… 20 In our study, most patients underwent multiple segment resection or extended resection, consistent with the previous studies. 17 Population-based studies have shown that colorectal neoplasms without signs of deep submucosal invasion can be treated by ER (ESD or EMR), which could reduce the incidence and mortality of CRC. In a multicenter study conducted in Japan, colorectal polyps (2 cm and larger) were removed by ER, 9.9% of which were staged as T1.…”

A novel risk prediction nomogram for early death in patients with resected synchronous multiple primary colorectal cancer based on the SEER database

“…However, SMPCC patients are more likely to suffer from postoperative complications and early death than SPCRC as they tend to require more extensive surgery. 9,17 Therefore there is a need to identify survival risk factors for SMPCC to optimize the treatment for these patients. To the best of our knowledge, this is the rst study to construct a prognostic prediction nomogram that could be used to predict all-cause and cancer-speci c early death in patients with resected SMPCC.…”

“…As a result, patients with SMPCC tend to have a higher incidence of postoperative complications and mortality than those diagnosed with SPCRC. 9 However, although numerous studies have evaluated the long-term prognosis of SMPCC, relatively few studies have assessed the short-term outcome. [10][11][12] As a result, there is currently no effective tool that could be used to predict short-term mortality for SMPCC patients.…”