Postoperative Outcomes of Screen-Detected vs Non–Screen-Detected Colorectal Cancer in the Netherlands

Abstract

The nationwide fecal immunochemical test-based screening program has influenced surgical care for patients with colorectal cancer (CRC) in the Netherlands, although these implications have not been studied in much detail so far. OBJECTIVE To compare surgical outcomes of patients diagnosed as having CRC through the fecal immunochemical test-based screening program (screen detected) and patients with non-screen-detected CRC. DESIGN, SETTING, AND PARTICIPANTS This was a population-based comparative cohort study using the Dutch ColoRectal Audit and analyzed all Dutch hospitals performing CRC resections. Patients who underwent elective resection for CRC between January 2011 to December 2016 were included. INTERVENTIONS Colorectal cancer surgery. MAIN OUTCOMES AND MEASURES Postoperative nonsurgical complications, postoperative surgical complications, postoperative 30-day or in-hospital mortality, and complicated course (postoperative complication resulting in a hospital stay >14 days and/or a reintervention and/or mortality). A risk-stratified comparison was made for different postoperative outcomes based on screening status (screen detected vs not screen detected), cancer stage (I-IV), and for cancer stage I to III also on age (aged Յ70 years and >70 years) and American Society of Anesthesiologists score (I-II and III-IV). To determine any residual case-mix-corrected differences in outcomes between patients with screen-detected and non-screen-detected cancer, univariable and multivariable logistic regression analyses were performed. RESULTS In total, 36 242 patients with colon cancer and 17 416 patients with rectal cancer were included for analysis. Compared with patients with non-screen-detected CRC, screen-detected patients were younger (mean [SD] age, 68 [5] vs 70 [11] years), more often men (3777 [60%] vs 13 506 [57%]), and had lower American Society of Anesthesiologists score (American Society of Anesthesiologists score III+: 838 [13%] vs 5529 [23%]). Patients with stage I to III colon cancer who were screen detected had a significantly lower mortality and complicated course rate compared with non-screen-detected patients. For patients with rectal cancer, only a significant difference was found in mortality rate in patients with a cancer stage IV disease, which was higher in the screen-detected group. Compared with non-screen-detected colon cancer, an independent association was found for screen-detected colon cancer on nonsurgical complications (adjusted odds ratio, 0.81; 95% CI, 0.73-0.91), surgical complications (adjusted odds ratio, 0.80; 95% CI, 0.72-0.89), and complicated course (adjusted odds ratio, 0.80; 95% CI, 0.71-0.90). Screen-detected rectal cancer had significantly higher odds on mortality. CONCLUSIONS AND RELEVANCE Postoperative outcomes were significantly better for patients with colon cancer referred through the fecal immunochemical test-based screening program compared with non-screen-detected patients. These differences were not found in patients with rectal cancer. The outcomes of patients wit...

Survival after local excision for rectal cancer: a population-based overview of clinical practice and outcome

“…This is probably due to the improvement of pre-operative imaging using MRI and to adjustment of the guidelines in the Netherlands in which short course radiotherapy was no longer advised in clinically node-negative patients from 2012 [24,25]. The implementation of a nationwide screening program for colorectal cancer is another reason for the relatively steep increase in 2014 and 2015 [17,26].…”

Preoperative optimization of physical functioning in patients with colorectal cancer

“…This test is the gold standard test to assess a patient's aerobic capacity [51] and can support clinical decision-making [52]. Research addressing the usefulness of more practical performance-based tests that estimate aerobic capacity for preoperative risk stratification, such as the incremental shuttle walk test, stair-climbing test, and 6-minute walk test is increasing [53][54][55][56]. Figure 4 shows a schematic hypothesis of the change in functional status during treatment with the addition of prehabilitation.…”

“…The survey study (chapter 2), with a response rate of 79%, gave insight in the variation in current clinical physical therapy practice in the Netherlands and compared these findings to the best available evidence-and practice-based conceptual models in the field of pre-and postoperative physical therapy management concerning major abdominal surgery. The study in chapter 3 provided information on preoperative physical fitness, postoperative outcomes, and the importance of surgical procedures and the national screening program concerning postoperative outcomes [56]. However, it was not possible to predict postoperative outcomes with the tests performed during the preoperative screening, probably due to the small number of patients that suffered from a postoperative complication (lack of statistical power).…”

“…Based upon our data and data from previous research, the Dutch national screening program has led to changes in the make-up and characteristics of the population of patients with colorectal cancer. Patients identified via this program were younger, more often were men, and had a lower American society of Anesthesiologists (ASA) score compared to patients that were not identified via the screening program [19,56]. These changes can influence the patient profile, disease-and treatment related outcomes, postoperative outcomes, and possibly long-term outcomes.…”

“…These changes can influence the patient profile, disease-and treatment related outcomes, postoperative outcomes, and possibly long-term outcomes. Literature shows that surgery in patients identified via the screening program had significantly lower morbidity and mortality rates [56]. This program can discriminate between patients with different disease stages of colorectal cancer and contributes to a more proactive approach, in which the screening is used to make proper treatment decisions.…”