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PWE-291 Falling emergency operation rates and reduced mortality after colon cancer surgery in england: a cohort study
  1. BE Byrne1,
  2. CA Vincent2,
  3. J Stebbing3,
  4. A Darzi4,
  5. OD Faiz5
  1. 1Patient Safety Translational Research Centre, Imperial College London, London
  2. 2Department of Experimental Psychology, University of Oxford, Oxford
  3. 3Department of Surgery and Cancer
  4. 4Surgery and Cancer, Imperial College London, London
  5. 5Surgical Epidemiology, Trials and Outcome Centre, St Mark–s Hospital, Harrow, UK

Abstract

Introduction Recent years have seen many changes within colorectal surgery. Laparoscopic techniques, fast track management, and bowel cancer screening have become widespread. This study examined changes in surgical treatment and outcomes for colon cancer over time against background registration rates, with subgroup analysis by urgency and age.

Method Annual data on colon cancer registrations and population size was obtained. Administrative data were used to identify adults undergoing colonic resection for cancer in England between April 1998 and March 2012. Cancer registrations, treatment and mortality rates were age-standardised. The proportion of registrations undergoing surgery was examined, and subgroups were analysed by urgency of admission and age group. Temporal trends were assessed using the Joinpoint Regression Program (National Cancer Institute, USA).

Results The standardised rate of colon cancer registration rose from 27.1 to 29.1 per 100 000 population. The proportion of registrations undergoing surgery fell, from approximately 67% to 57% (Annual Percentage Change = −1.44, p < 0.05), due to a significant fall in non-elective operating; the elective treatment rate did not change. Postoperative 90-day mortality rates fell across all age groups for elective and non-elective surgery, from approximately 6.5% to 3% and 19% to 13%, respectively.

Conclusion Colon cancer registrations increased over time. The surgical treatment rate per colon cancer fell, due to falling rates of non-elective surgery. Possible explanations include improved early detection of colon cancer, changes in case selection, and improvements in non-surgical treatments. Postoperative mortality fell significantly after elective and non-elective surgery for all age groups. Considered together, these findings suggest a global improvement in the quality of surgical care for colon cancer. Future studies should include non-surgical treatments with information on stage of cancer at presentation.

Disclosure of interest None Declared.

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