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Original article
Population-based assessment of the outcomes in patients with postcolonoscopy colorectal cancers
  1. Anand Govindarajan1,2,
  2. Linda Rabeneck2,3,4,5,
  3. Lingsong Yun2,
  4. Jill Tinmouth2,3,4,5,
  5. Lawrence F Paszat2,5,
  6. Nancy N Baxter2,5,6
  1. 1Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
  2. 2Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
  3. 3Cancer Care Ontario, Toronto, Ontario, Canada
  4. 4Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  5. 5Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  6. 6Department of Surgery, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Anand Govindarajan, Department of Surgery, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Suite 1220, Toronto, Ontario, Canada M5G1X5; agovindarajan{at}mtsinai.on.ca

Abstract

Objective The potential for cancers to not be detected on colonoscopy is increasingly recognised, but little is known about patient outcomes. The objective of this study was to assess the outcomes of patients diagnosed with postcolonoscopy colorectal cancers (PCCRCs).

Design We conducted a population-based retrospective cohort study, including all patients diagnosed with colorectal cancer (CRC) in Ontario, Canada from 2003 to 2009. Patients were categorised into three groups: DETECTED (diagnosed within 6 months of first colonoscopy), PCCRC (diagnosed 6–36 months after first colonoscopy) or NOSCOPE (no colonoscopy within 36 months of diagnosis). Univariate and multivariable analyses were conducted to study overall survival, surgical treatment, emergency presentation and surgical complications.

Results Overall, 45 104 patients were included, with 2804 being classified as having a PCCRC. Compared with the DETECTED group, PCCRC was associated with a significantly higher likelihood of stage IV disease (17.2% vs 12.9%), worse overall survival (5 year OS: 60.8% vs 68.3%, p<0.0001; adjusted HR: 1.25, 95% CI 1.17 to 1.32, p<0.0001), a higher likelihood of emergency presentation (OR: 2.86, 95% CI 2.56 to 3.13, p<0.001) and lower likelihood of surgical resection (OR: 0.61, 95% CI 0.55 to 0.67, p<0.001). However, patients with PCCRC had significantly better outcomes than those in the NOSCOPE group (stage IV: 37.1%, 5 year OS: 38.9%)

Conclusions Compared with CRC detected by colonoscopy, PCCRCs are associated with a higher risk of emergent presentation, a lower likelihood of surgical resection and most notably, significantly worse oncological outcomes. However, they have better outcomes than patients with no recent colonoscopy.

  • COLORECTAL CARCINOMA
  • COLONOSCOPY

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