IMPORTANCE Screening colonoscopy seemingly decreases colorectal cancer rates in the United States. In addition to removing benign lesions and preventing progression to malignancy, screening colonoscopy theoretically identifies asymptomatic patients with early-stage disease, potentially leading to higher survival rates.OBJECTIVES To assess the effect of screening colonoscopy on outcomes of colon cancer surgery by reviewing differences in staging, disease-free interval, risk of recurrence, and survival and to identify whether diagnosis through screening improves long-term outcomes independent of staging. RESULTS A total of 1071 patients were included, with 217 diagnosed through screening. Patients not diagnosed through screening were at risk for a more invasive tumor (ՆT3: relative risk [RR] = 1.96; P < .001), nodal disease (RR = 1.92; P < .001), and metastatic disease on presentation (RR = 3.37; P < .001). In follow-up, these patients had higher death rates (RR = 3.02; P < .001) and recurrence rates (RR = 2.19; P = .004) as well as shorter survival (P < .001) and disease-free intervals (P < .001). Cox and logistic regression controlling for staging and baseline characteristics revealed that death rate (P = .02) and survival duration (P = .01) were better stage for stage with diagnosis through screening. Death and metastasis rates also remained significantly lower in tumors without nodal or metastatic spread (all P < .001).CONCLUSIONS AND RELEVANCE Patients with colon cancer identified on screening colonoscopy not only have lower-stage disease on presentation but also have better outcomes independent of their staging. Compliance to screening colonoscopy guidelines can play an important role in prolonging longevity, improving quality of life, and reducing health care costs through early detection of colon cancer.

Our study underlines the oncological safety of a transverse colectomy for mid-transverse colon cancer. Although TC tumors were associated with poorer histopathological features, survival rates were comparable.

An involved radial margin leads to high rates of conversion and multivisceral resection. Although occurring infrequently, RMP is an important stage-independent outcome predictor strongly associated with recurrence, risk of death, and shorter survival. Preoperative assessment, especially imaging, could play a key role in the timely identification of potential patients with RMP to take adequate preparatory surgical and therapeutic measures.

The inverse relation between treatment delay and survival and recurrence reflected adequate prioritization of advanced and high-risk cases and concurrently showed that, matched for stage and risk categories, treatment delay was not associated with worse cancer outcomes for patients with colon cancer. A reasonable delay between diagnosis and subsequent surgery is not detrimental to patient outcomes and permits more flexibility in scheduling and justifies allowing time to complete proper preoperative evaluation and staging, improving the quality and safety of resection and treatment.

Background Obese patients may face higher complication rates during surgical treatment of colon cancer. This paper aims to measure this effect in a high volume tertiary care center. Methods All colon cancer patients treated surgically at our center from 2004 through 2011 were reviewed. Multivariate regression assessed relationships of complications and stay outcomes with BMI controlled for age, gender, comorbidity score, surgical approach and history of smoking. Results In 1048 included patients, BMI was a predictor of several complications in both laparoscopic and open procedures. For every increase of BMI by one WHO category, the odds ratio (OR) was 1.61 (p<0.001) for wound infection and OR=1.54 for slow healing (p<0.001). Additionally, right colectomies had an OR=3.23 (p=0.017) for wound dehiscence. No further associations with BMI were found. Conclusions BMI was incrementally associated with wound-related complications, illustrating how the proliferation of obesity relates to a growing risk of surgical complications. As the surgical community strives to improve quality of care, patient controllable factors will play an increasingly important role in cost containment and quality improvement.

Background and Objectives: Vascular invasion, in particular extramural venous invasion (EMVI), is a pathologic characteristic that has been extensively studied in rectal cancer but rarely in colon cancer. This study aims to evaluate its prognostic role in stage II-III colon cancer. Methods: All stage II-III colon cancer patients who underwent surgery between 2004–2015 were reviewed. We divided the study group into patients without invasion, with intramural invasion only (IMVI), EMVI only, and both IMVI/EMVI (n=923). Results: EMVI was associated with other high-risk features, including T4, N+ disease, lymphatic, and perineural invasion (P<0.001). EMVI+ patients had considerably higher rates of locoregional and distant recurrence and subsequently disease-specific mortality (stage-II: odds ratio (OR) 3.64, P=0.001, stage-III OR:1.94, P=0.009), whereas outcomes were comparable between IMVI and no vascular invasion (OR:1.21, P=0.764, OR:1.28, P=0.607, respectively). The adjusted hazard ratios for EMVI+ patients on disease-free survival, and disease-specific survival were 2.07 (P<0.001), 1.67 (P=0.027), respectively. Moreover, EMVI+ stage-II patients fared worse than EMVI– stage-III patients, even after adjusting for adjuvant chemotherapy. Conclusion: EMVI is a strong predictor for worse oncologic outcomes in stage II-III colon cancer patients, whereas IMVI is not. It is also associated with worse outcomes compared in patients with higher stage disease who are EMVI negative.

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This SSI risk assessment factor provides a simple tool using readily available characteristics to stratify patients by SSI risk and identify patients at risk during their postoperative admission. Thereby, it can be used to potentially focus frequent monitoring and more aggressive preventive efforts on high-risk patients.