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Observational Study
. 2018 Dec 24;3(2):210-217.
doi: 10.1002/bjs5.50125. eCollection 2019 Apr.

National cohort study on postoperative risks after surgery for submucosal invasive colorectal cancer

N C A Vermeer  1 , Y Backes  2   3 , H S Snijders  4 , E Bastiaannet  1   5 , G J Liefers  1 , L M G Moons  2   3 , C J H van de Velde  1 , K C M J Peeters  1 ; Dutch T1 Colorectal Cancer Working Group
Affiliations
Observational Study

National cohort study on postoperative risks after surgery for submucosal invasive colorectal cancer

N C A Vermeer et al. BJS Open. .

Abstract

Background: The decision to perform surgery for patients with T1 colorectal cancer hinges on the estimated risk of lymph node metastasis, residual tumour and risks of surgery. The aim of this observational study was to compare surgical outcomes for T1 colorectal cancer with those for more advanced colorectal cancer.

Methods: This was a population-based cohort study of patients treated surgically for pT1-3 colorectal cancer between 2009 and 2016, using data from the Dutch ColoRectal Audit. Postoperative complications (overall, surgical, severe complications and mortality) were compared using multivariable logistic regression. A risk stratification table was developed based on factors independently associated with severe complications (reintervention and/or mortality) after elective surgery.

Results: Of 39 813 patients, 5170 had pT1 colorectal cancer. No statistically significant differences were observed between patients with pT1 and pT2-3 disease in the rate of severe complications (8·3 versus 9·5 per cent respectively; odds ratio (OR) 0·89, 95 per cent c.i. 0·80 to 1·01, P = 0·061), surgical complications (12·6 versus 13·5 per cent; OR 0·93, 0·84 to 1·02, P = 0·119) or mortality (1·7 versus 2·5 per cent; OR 0·94, 0·74 to 1·19, P = 0·604). Male sex, higher ASA grade, previous abdominal surgery, open approach and type of procedure were associated with a higher severe complication rate in patients with pT1 colorectal cancer.

Conclusion: Elective bowel resection was associated with similar morbidity and mortality rates in patients with pT1 and those with pT2-3 colorectal carcinoma.

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Figures

Figure 1
Figure 1
Study flow chart of included patients. DSCA, Dutch Surgical Colorectal Audit; TEM, transanal endoscopic microsurgery
Figure 2
Figure 2
Distribution of surgically treated patients with colorectal cancer over time according to pT category. *P < 0·001 (pT1 2009 versus pT1 2016, χ2 test)
Figure 3
Figure 3
Contribution of screening‐detected tumours in patients with pT1 colorectal cancer treated surgically after implementation of mass screening programme in 2014. *P < 0·001 (χ2 test)
Figure 4
Figure 4
Risk of severe complications (reintervention and/or mortality within 30 days) after colorectal surgery in patients with pT1 and pT2–3 colorectal cancer. Risk of complications in a women and b men with ASA grade I–II and III–IV fitness (pT1: 427 events in 5170 patients; pT2–3: 3284 events in 34 643 patients). Increasing risk is indicated by change in colour from dark green to light green to yellow to orange to red. Values in parentheses are 95 per cent confidence intervals. *Includes ileocaecal resection and transverse resection. n.a., Not applicable (sample size too small); LAR, low anterior resection; APR, abdominoperineal resection
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References

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