Introduction National bowel cancer screening programme was started in April 2006 across England. Our institution became one of the centres for screening colonoscopy in September 2008. The aim of this study is to compare the clinical and oncological outcomes of symptomatic vs. screen detected colorectal cancers.
Method This is a single centre retrospective study of prospectively collected data of patients diagnosed with colorectal cancer following screening colonoscopy or symptomatic presentation from September 2008 to December 2013 using PMAS database. Data were analysed using Microsoft Excel 2010.
Results Over a period of 5 years, 199 patients were diagnosed through screening colonoscopy while 791 cancers were symptomatic. The mean age was 67.5 and 72.85 years in screen detected and symptomatic cancers respectively. 59.8% patients were male in screening group compared to 54.7% in symptomatic group. Incidence of colon cancer was slightly higher in screening group (70% vs. 67.8%) but more so in sigmoid colon. Colonoscopy was successful in 95% of screening cases but only 55.2% in symptomatic group. Only 3% of patients in screening group did not have any surgical procedure compared to 12.8% in symptomatic group. The laparoscopic resection was achieved in 74% patients in screening group compared to 61% in symptomatic group. There was significant difference in permanent stoma rate (2% in screening group compared 9% in symptomatic group) but there was no difference in defunctioning stoma rates. Curative resection was achieved in significantly higher number of patients in screening group (96.9%) compared to symptomatic group (63.8%). Median hospital stay was 4 and 6 days in screening and symptomatic groups respectively. There was no difference in major complications between two groups including postoperative death, anastomotic leaks and DVT. Duke’s distribution revealed 45% vs. 15% of A, 28% vs. 31% of B, 25% vs. 35% of C and 2% vs. 19% of D stage tumours in screen vs symptomatic group. The overall recurrence rate was significantly lower in screening group (8.5%) compared to symptomatic group (18.6%). The overall recurrence free survival was 28 and 24 months respectively in screening group and symptomatic group.
Conclusion Colonoscopy as a part of national bowel cancer screening programme has improved the detection rate of colorectal cancer at an earlier stage. It has also demonstrated decreased recurrence rate and permanent stoma rate with encouraging recurrence free survival rates compared to symptomatic cancers.
Disclosure of interest None Declared.
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