Impact of bowel cancer screening on the management of colorectal cancer

Hwang, MJ; Evans, Tim; Lawrence, Gavin P.; Karandikar, Sharad

doi:10.1111/codi.12562

Cited by 10 publications

(6 citation statements)

References 25 publications

(33 reference statements)

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“…Many researchers suggested that efforts should be made to decrease the need for emergency resection in CRC patients. As previously reported, the popularity of early screening project and awareness of symptoms campaign may be useful to reduce the rate of emergency presentations [45][46][47]. In the future, we expected that short-term outcomes and longterm survival of CRC patients could be further improved with the increasing prevalence of health education, early detection and prevention measures.…”

Section: Discussionmentioning

confidence: 81%

Comparison of short-term surgical outcomes and long-term survival between emergency and elective surgery for colorectal cancer: a systematic review and meta-analysis

Zhou

Jin

Wang

et al. 2023

Int J Colorectal Dis

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Objective: The objective of this study was to summarize relevant data from previous reports and perform a meta-analysis to compare short-term surgical outcomes and long-term oncological outcomes between emergency and elective surgery for colorectal cancer(CRC).Methods: A systematic literature search was performed using PubMed and Embase databases and relevant data were extracted. Postoperative morbidity, hospital mortality within 30 days, postoperative recovery, overall survival(OS) and relapse-free survival(RFS) were compared using a xed or random-effect model.Results: 28 studies involving 353,686 participants were enrolled for this systematic review and meta-analysis, and 23.5% (83,054/353,686) of CRC patients underwent emergency surgery. The incidence of emergency presentations in CRC patients ranged from 2.7% to 38.8%. Lymph node yield of emergency surgery was comparable to that of elective surgery(WMD:0.70, 95%CI:-0.74,2.14, P=0.340; I 2 =80.6%). Emergency surgery had a higher risk of postoperative complications(OR:1.83, 95%CI:1.62-2.07, P<0.001; I 2 =10.6%) and hospital mortality within 30 days(OR:4.62, 95%CI:4.18-5.10, P<0.001; I 2 =42.9%) than elective surgery for CRC. In terms of long-term oncological outcomes, emergency surgery was signi cantly associated with poorer RFS (HR: 1.51, 95%CI:1.24-1.83, P<0.001; I 2 =58.9%) and OS(HR:1.60, 95%CI: 1.47-1.73, P<0.001; I 2 =63.4%) of CRC patients. In addition, the subgroup analysis for colon cancer patients revealed a pooled HR of 1.73 for OS(95% CI:1.52-1.96, P<0.001), without the evidence of signi cant heterogeneity(I 2 =21.2%).Conclusion: Emergency surgery for CRC had an adverse impact on short-term surgical outcomes and long-term survival. A focus on early screening programs and health education were warranted to reduce emergency presentations of CRC patients.The prognostic outcome of early CRC patients was excellent, whereas advanced CRC patients had a high risk of recurrence and poor survival [1]. According to the previous reports, approximately 9.5%-30.3% of CRC patients underwent emergency surgery due to bowel obstruction, perforation, or bleeding [3][4][5][6]. While incidence may vary, what is clear is that the emergency presentation and treatment of CRC has become a challenging concern on public health.Due to emergent complications such as bowel obstruction, perforation and/or bleeding caused by the primary lesion, immediate surgical intervention is usually indispensable for CRC patients. Many studies have reported that emergency surgery resulted in a high incidence of postoperative morbidity and mortality[7-10]. However, there is no consensus on the association between emergency surgery and poor perioperative outcomes. In terms of longterm oncological outcomes, a few studies identi ed emergency surgery as a negative predictive factor for recurrence and survival in CRC patients [3][4][5][6]11,12]. However, the similar ndings were not observed in other studies, especially after adjusting for baseline characteristics of CRC patients [13][14][15][16][17...

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Section: Discussionmentioning

confidence: 81%

Comparison of short-term surgical outcomes and long-term survival between emergency and elective surgery for colorectal cancer: a systematic review and meta-analysis

Zhou

Jin

Wang

et al. 2023

Int J Colorectal Dis

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“…Similar observations have been made in England, where the introduction of CRC screening was followed by a reduction in the emergency surgery rate, falling to 12% in the screening age group compared with 16% overall. 28 In Scotland, a reduction of emergency admissions from 20% to 11% was observed in screening participants compared with controls. 29 Also in Scotland, a reduction from 20% to 13% of patients with emergency presentation of CRC prior to surgery was observed over time after the introduction of CRC screening.…”

Section: Discussionmentioning

confidence: 99%

Screening vs. non-screening detected colorectal cancer: Differences in pre-therapeutic work up and treatment

et al. 2016

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Objectives To compare preoperative staging, multidisciplinary team-assessment, and treatment in patients with screening detected and non-screening detected colorectal cancer. Methods Data on patient and tumour characteristics, staging, multidisciplinary team-assessment and treatment in patients with screening and non-screening detected colorectal cancer from 2008 to 2012 were collected from the Stockholm-Gotland screening register and the Swedish Colorectal Cancer Registry. Results The screening group had a higher proportion of stage I disease (41 vs. 15%; p < 0.001), a more complete staging of primary tumour and metastases and were more frequently multidisciplinary team-assessed than the non-screening group ( p < 0.001). In both groups, patients with endoscopically resected cancers were less completely staged and multidisciplinary team-assessed than patients with surgically resected cancers ( p < 0.001). No statistically significant differences were observed between the screening and non-screening groups in the use of neoadjuvant treatment in rectal cancer (68 vs.76%), surgical treatment with local excision techniques in stage I rectal cancer (6 vs. 9%) or adjuvant chemotherapy in stages II and III disease (46 vs. 52%). Emergency interventions for colorectal cancer occurred in 4% of screening participants vs. 11% of non-compliers. Conclusions Screening detected cancer patients were staged and multidisciplinary team assessed more extensively than patients with non-screening detected cancers. Staging and multidisciplinary team assessment prior to endoscopic resection was less complete compared with surgical resection. Extensive surgical and (neo)adjuvant treatment was given in stage I disease. Participation in screening reduced the risk of emergency surgery for colorectal cancer.

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“…As previously reported, the popularity of early screening project and awareness of symptoms campaign may be helpful to reduce the rate of emergency presentations for colorectal cancer. [45][46][47] In the future, we expected that short-term surgical outcomes and long-term survival of colorectal cancer patients could be improved with the increasing prevalence of health education, early detection and prevention measures.…”

Section: Discussionmentioning

confidence: 99%

Comparison of short-term surgical outcome and long-term survival between emergency and elective surgery for colorectal cancer: A systematic review and meta-analysis

Zhou

Jin

Wang

et al. 2022

Preprint

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Background: The objective of this study was to summarize data from previous relevant reports and perform a meta-analysis to compare short-term surgical outcomes and long-term oncological outcomes between emergency resection and elective resection for colorectal cancer(CRC). Methods: A systematic literature search was performed using PubMed and Embase databases and relevant data were extracted. Postoperative morbidity and mortality within 30 days, postoperative recovery, overall survival(OS) and relapse-free survival(RFS) of the two surgical nature were compared using a fixed or random-effect model. Results: In total, we identified 28 relevant studies involving 353,686 participants for this systematic review and meta-analysis, and 23.5%(83,054/353,686) of CRC patients underwent emergency surgery. Based on the included reports, the incidence of emergency presentations in CRC patients ranged from 2.7% to 38.8%. Lymph node yield of emergency surgery was comparable to that of elective surgery(WMD:0.70, 95%CI:-0.74,2.14, P=0.340; I2=80.6%). Emergency surgery had a higher risk of postoperative complications(OR:1.83, 95%CI:1.62-2.07, P<0.001; I2=10.6%) and mortality within 30 days(OR:4.62, 95%CI:4.18-5.10, P<0.001; I2=42.9%) than elective surgery for CRC. In terms of long-term oncological outcomes, emergency surgery significantly associated with recurrence(HR for RFS: 1.51, 95%CI:1.24-1.83, P<0.001; I2=58.9%) and poorer OS(HR:1.60, 95%CI: 1.47-1.73, P<0.001; I2=63.4%) in CRC patients. Subgroup analysis for colon cancer patients revealed a pooled HR of 1.73 for OS(95% CI:1.52-1.96, P<0.001), without evidence of significant heterogeneity(I2=21.2%). Conclusion: Emergency resection for CRC had an adverse impact on short-term surgical outcomes and long-term survival. A focus on early screening programs and health education were warranted to reduce emergency presentations of CRC patients.

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Impact of bowel cancer screening on the management of colorectal cancer

Abstract: The NBCSP has had a positive impact on elective and emergency surgery for CRC in the West Midlands.

Cited by 10 publications

References 25 publications

Comparison of short-term surgical outcomes and long-term survival between emergency and elective surgery for colorectal cancer: a systematic review and meta-analysis

Comparison of short-term surgical outcomes and long-term survival between emergency and elective surgery for colorectal cancer: a systematic review and meta-analysis

Screening vs. non-screening detected colorectal cancer: Differences in pre-therapeutic work up and treatment

Comparison of short-term surgical outcome and long-term survival between emergency and elective surgery for colorectal cancer: A systematic review and meta-analysis

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