Age and factors associated with access and time to post-operative adjuvant chemotherapy in colon cancer: a French epidemiological study

Capsec, Jean; Chupé, Fabienne; Heitzmann, P.; Raveneau, Céline; Dardaine-Giraud, Véronique; Sauger, Carine; Lagasse, Jean-Paul; Kraft, Kevin; Linassier, Claude; Dorval, Étienne

doi:10.21037/jgo.2017.06.13

Cited by 6 publications

(3 citation statements)

References 21 publications

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“…Cancer care quality also seems to be preserved at the continuity of care management moment, with both groups receiving appropriate and timely referrals to medical oncology. Current literature in this domain is limited, with one study at a tertiary care center corroborating our findings [ 8 ]; however, a French study of 24 regional hospitals found that emergency surgery was independently associated with longer time to receipt of adjuvant chemotherapy [ 18 ]. Several studies have also found an association between emergency surgery and non-receipt of adjuvant chemotherapy [ 10 , 11 ].…”

Section: Discussionsupporting

confidence: 75%

Quality of Colon Cancer Care in Patients Undergoing Emergency Surgery

et al. 2021

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Thirty percent of colon cancer diagnoses occur following emergency presentations, often with bowel obstruction or perforation requiring urgent surgery. We sought to compare cancer care quality between patients receiving emergency versus elective surgery. We conducted an institutional retrospective matched (46 elective:23 emergency; n = 69) case control study. Patients who underwent a colon cancer resection from January 2017 to February 2019 were matched by age, sex, and cancer stage. Data were collected through the National Surgical Quality Improvement Program and chart review. Process outcomes of interest included receipt of cross-sectional imaging, CEA testing, pre-operative cancer diagnosis, pre-operative colonoscopy, margin status, nodal yield, pathology reporting, and oncology referral. No differences were found between elective and emergency groups with respect to demographics, margin status, nodal yield, oncology referral times/rates, or time to pathology reporting. Patients undergoing emergency surgery were less likely to have CEA levels, CT staging, and colonoscopy (p = 0.004, p = 0.017, p < 0.001). Emergency cases were less likely to be approached laparoscopically (p = 0.03), and patients had a longer length of stay (p < 0.001) and 30-day readmission rate (p = 0.01). Patients undergoing emergency surgery receive high quality resections and timely post-operative referrals but receive inferior peri-operative workup. The adoption of a hybrid acute care surgery model including short-interval follow-up with a surgical oncologist or colorectal surgeon may improve the quality of care that patients with colon cancer receive after acute presentations. Surgeons treating patients with colon cancer emergently can improve their care quality by ensuring that appropriate and timely disease evaluation is completed.

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Section: Discussionsupporting

confidence: 75%

Quality of Colon Cancer Care in Patients Undergoing Emergency Surgery

et al. 2021

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“…Therefore, genistein and luteolin could enhance the efficacy of chemotherapy. The adverse effect of genistein and luteolin on the long-term outcome of CRC patients without adjuvant chemotherapy may be due to the factors resulting in undertreatment, such as old age, comorbidities [26,27,28]. Indeed, elderly patients and those with a CVD history in this study had a higher level of genistein concentration.…”

Section: Discussionmentioning

confidence: 75%

Serum Concentration of Genistein, Luteolin and Colorectal Cancer Prognosis

et al. 2019

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Although flavonoid phytoestrogens have been suggested to be associated with reduced risk of colorectal cancer (CRC), their influence on CRC prognosis remains uncertain. A population-based cohort of 2051 patients diagnosed with stage I–III CRC in southwest Germany in 2003–2010 were followed for five years. Post-diagnostic serum concentration of genistein and luteolin were measured using Ultra-Performance Liquid Chromatography with mass spectrometry. Multivariable Cox regression analysis was conducted to calculate the Hazard Ratios (HRs) and 95% confidence interval (CI) for the association between flavonoids concentration and overall morality, CRC-specific mortality, CRC recurrence, and disease-free survival (DFS). Median (interquartile range) serum concentration of genistein and luteolin was 11.90 ng/µL (10.08–14.13) and 7.20 ng/µL (6.40–8.16), respectively. Neither serum genistein nor luteolin was associated with CRC prognosis. There was no clear evidence of departure from linearity. However, the association might be differential by adjuvant chemotherapy. Associations pointed towards lower risk in patients who received chemotherapy and higher risk in those without chemotherapy for overall mortality regarding serum genistein (P-interaction = 0.02) and correspondingly for CRC recurrence (P-interaction: 0.03) and DFS (P-interaction: 0.01) with respect to luteolin. Our study provides little evidence that serum genistein and luteolin are associated with colorectal cancer prognosis. Future studies are warranted to evaluate the potential interaction with adjuvant chemotherapy.

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“…Analyzing postoperative treatment, we found that the time to start adjuvant chemotherapy was similar between the emergency and elective group, suggesting that the recovery after surgery was not prolonged and the cancer work-up was not delayed. A French study with 404 patients reported a longer time to start adjuvant chemotherapy; however, other studies showed no delay [ 3 , 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Emergency resection is an independent risk factor for decreased long-term overall survival in colorectal cancer: a matched-pair analysis

Esswein,

Ninkovic,

Gasser

et al. 2023

World J Surg Onc

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Background Colorectal cancer is one of the most common malignant neoplasms worldwide. Up to 30% of the patients present in an emergency setting despite an established screening program. Emergency colorectal resection is associated with increased mortality and morbidity as well as worse oncological outcome. This study aims to analyze the impact on tumor recurrence and survival in patients with an emergency colorectal resection, independent of sex, age, and tumor stage. Methods Patients, who underwent an oncological resection for colorectal cancer at the Medical University of Innsbruck, Department of Visceral, Transplant and Thoracic Surgery, between January 2003 and December 2018 were analyzed retrospectively and screened for emergency resections. Matched pairs were formed to analyze the impact of emergency operations on long-term outcomes, considering tumor stage, sex, and age, comparing it with elective patients. Results In total, 4.5% out of 1297 patients underwent surgery in an emergency setting. These patients had higher UICC (Union internationale contre le cancer) stages than elective patients. After matching the patients for age, sex, and tumor stage, emergency patients still had higher mortality. The incidence of recurrence was higher (47.5% vs. 25.4%, p = 0.003) and the 5-year overall survival decreased (35.6% vs. 64.4%, p < 0.001) compared to the matched patients with elective resection. Correcting for 90-day mortality still a reduction in the 5-year overall survival was demonstrated (44% vs. 70%, p = 0,001). The left-sided colon tumors were more common in the emergency group (45.8% vs. 25.4%, p = 0.006) and the rectal tumors in the elective one (21.2% vs. 3.4%, p = 0.002). Conclusion Patients undergoing emergency resection for colorectal cancer have a decreased tumor-specific and overall survival compared to patients after elective resection, independent of age, sex, and tumor stage, even after correcting for 90-day mortality. These findings confirm the importance of colorectal cancer awareness and screening to reduce emergency resections.

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Age and factors associated with access and time to post-operative adjuvant chemotherapy in colon cancer: a French epidemiological study

Cited by 6 publications

References 21 publications

Quality of Colon Cancer Care in Patients Undergoing Emergency Surgery

Quality of Colon Cancer Care in Patients Undergoing Emergency Surgery

Serum Concentration of Genistein, Luteolin and Colorectal Cancer Prognosis

Emergency resection is an independent risk factor for decreased long-term overall survival in colorectal cancer: a matched-pair analysis

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