Morbidity and mortality following major large bowel resection for colorectal cancer detected by a population-based screening program

Abstract

Background and aims In 2008, Ontario initiated a population-based colorectal screening program using guaiac fecal occult blood testing. This work was undertaken to fill a major gap in knowledge by estimating serious post-operative complications and mortality following major large bowel resection of colorectal cancer detected by a population-based screening program. Methods We identified persons with a first positive fecal occult blood result between 2008 and 2016, at the age of 50–74 years, who underwent a colonoscopy within 6 months, and proceeded to major large bowel resection for colon cancer within 6 months or rectosigmoid/rectal cancer within 12 months, and identified an unscreened cohort of resected cases diagnosed during the same years at the age of 50–74 years. We identified serious postoperative complications and readmissions ≤30 days following resection, and postoperative mortality ≤30 days, and between 31 and 90 days among the screen-detected and the unscreened cohorts. Results Serious post-operative complications or readmissions within 30 days were observed among 1476/4999 (29.5%) cases in the screen-detected cohort, and among 3060/8848 (34.6%) unscreened cases. Mortality within 30 days was 43/4999 (0.9%) among the screen-detected cohort, and 208/8848 (2.4%) among the unscreened cohort. Among 30 day survivors, mortality between 31 and 90 days was 28/4956 (0.6%) and 111/8640 (1.3%), respectively. Conclusion Serious post-operative complications, readmissions, and mortality may be more common following major large bowel resection for colorectal cancer between the ages of 50 and 74 among unscreened compared to screen-detected cases.

Refining the Risk of Lymph Node Metastasis in T1 Colorectal Adenocarcinoma

“…It is critical that gastroenterologists and surgeons have the information they need to counsel patients appropriately when deciding whether to opt for endoscopic or local excision alone vs traditional oncologic resection. 7 Although colorectal surgical morbidity and mortality have improved, particularly in screened populations, 8 risks of therapeutic endoscopic resection are significantly lower and functional outcomes are excellent. 9 With the increasing availability of advanced endoscopic procedures, it is essential that better data are available to physicians and patients to avoid overtreatment of early cancers.…”

“…4 Although evidence suggests that the use of these drugs could lead to different adverse effects, including an increased risk of fractures, interstitial nephritis, hepatic encephalopathy, anemia, and cognitive decline, most of the available data are based on observational studies and, therefore, could be susceptible to interpretation bias. [5][6][7][8][9] Despite a large number of studies, the overall quality of evidence for PPIs adverse effects is low to very low 10 and it is difficult, therefore, to rigorously establish whether the described side effects are properly attributable to the use of the drug exposure after correct prescription or whether they are a consequence of inappropriate and unregulated use. 11,12 Furthermore, because it remains difficult to find a consensus regarding the real side effects attributable to this class of drugs in the general population, the correct definition of these effects in patients with liver cirrhosis is even more complicated and the real effect of PPIs on cirrhotic patients remains controversial.…”