The impact of screening on short-term outcome after surgery for colorectal cancer

Abstract

Aim: To investigate the influence of a screening program on the short-term outcome of patients undergoing surgery for colorectal cancer.Methods: Between April 2010 and December 2012 patients diagnosed with colorectal cancer via the screening program (n = 80) were compared with patients diagnosed elsewhere (n = 106). Only patients of ≥ 50 and ≤ 69 years of age diagnosed outside the program were selected as controls. The clinical variables included age, sex, American Society of Anesthesiologists (ASA) status, Charlson index, preoperative hemoglobin and serum albumin levels, surgical approach, tumor location and stage, perioperative transfusion and postoperative morbidity. A multivariate analysis was used to identify variables independently associated with outcome.Results: There were no significant differences with regard to age, sex and ASA status. Preoperative hemoglobin (14.1 ± 1.6 g/ dl vs 12.3 ± 2.3 g/dl; p < 0.001) and serum albumin (4.45 ± 0.26 g/dl vs 4.0 ± 0.6 g/dl; p < 0.001) levels were significantly higher in the screening group. The overall morbidity was significantly lower in the screening group (38.8% vs 63.2; p < 0.001) and mainly related to a higher rate of Clavien-Dindo grade II complications in controls. There were no differences with regard to wound infection, postoperative ileus, anastomotic leakage or reoperations. The median length of hospital stay was shorter in the screening group (6 vs 9 days; p = 0.003). Multivariate analysis showed that diagnosis outside the screening program, type of surgical procedure, open surgery and Charlson index were independent risk factors for postoperative complications.Conclusions: The diagnosis of colorectal cancer via the screening program is associated with a lower rate of postoperative minor complications and a shorter hospital stay.

The Relationship Between Co‐morbidity, Screen‐Detection and Outcome in Patients Undergoing Resection for Colorectal Cancer

“…For example, lower uptake of bowel screening has been shown to be associated with younger age, male sex and socioeconomic deprivation [ 7 ]. In agreement with previous work [ 7 – 9 , 13 ], screen-detected patients in this study were more likely to be male, less likely to have rectal cancers and there was a non-significant trend towards lower socioeconomic deprivation. As would be expected, SD tumours were of a significantly lower UICC-TNM stage and there were a significantly lower number of emergency operations in this group.…”

Short-term outcome of patients with colon cancer diagnosed by symptoms and screening

“…showed results that were in line with the results of Sebastian et al (1). We observed a significantly higher disease-free survival at five and ten years in patients diagnosed within the screening program (n = 200) as compared with those diagnosed following the appearance of symptoms (750).…”

“…We read the article "Lower morbidity and improved outcomes in patients with screen-detected colorectal cancer" and the accompanying editorial (1,2) with great interest. In this study, the authors reported that patients with colon cancer diagnosed as part of a screening program (n = 86) require fewer preoperative transfusions of blood products (3.5% vs 25%; p < 0.001) and also experience fewer overall postoperative complications than patients diagnosed outside such programs (n = 65) (35.4% vs 62.5%; p = 0.002).…”

Screening-detected colorectal cancers show better long-term survival compared with stage-matched symptomatic cancers

“…Although pathologic stage (TNM) and histologic parameters are the most important prognostic factors to determine long-term outcomes in CRC, there are other factors related to the host and surgical treatment which may have some bearing on our findings (14,15). Most authors agree that the subjects that voluntarily enroll in a screening program are more responsible, more health conscious, more likely to follow health care recommendations and usually have a better prognosis due to their habits and lifestyle.…”

“…However, a major limitation is its invasive nature, which is not always readily accepted by the general population (12,13). Several studies have reported differences in the histologic phenotype and survival in patients whose tumors were diagnosed via a screening program as opposed to those diagnosed as a result of clinical symptoms (10,(14)(15)(16)(17)(18).…”