Introduction Despite advances in non-surgical oncological treatments, surgical resection of the primary tumour is still required to “cure” a patient of colorectal cancer (CRC). Surgeon specific outcome reporting in colorectal cancer surgery focuses on patients who undergo major elective resection, raising a concern that only data for “low risk” patients are included, thus giving an incomplete picture of a Unit’s overall performance in the management of colorectal cancer. The aim of this study was to analyse the frequency, reasons and outcomes of patients who do not undergo resection.
Method Details of 1093 patients diagnosed with CRC in a single institution between April 2008 and April 2013 were recorded prospectively. Analysis of demographics, staging, treatment, reasons for non-surgical management and survival was performed. Patients who underwent local tumour resection were excluded (n = 40).
Results 827 (75.6%) patients underwent primary major resection of their tumour, of which 62 patients were stage IV at the time of surgery. 226 (24.4%) patients were treated non-operatively. Of these patients, 143 (63.2%) had Stage IV cancer (37 (25.9%) underwent palliative surgery). 44(19.5%) patients were deemed unfit for surgery, 2 (0.9%) had complete response to chemo-radiotherapy and 23(10.2%) patients declined surgical intervention.
During follow up (median 32 months, range 0–78 months), 253 (30.6%) patients who underwent a major resection died, with 175 deaths (69.2%) directly attributed to cancer. For the non-resection group, 182 (68.4%) patients died, with 137 deaths (75.3%) due to cancer.
Median survival for patients undergoing major resection was 45 months: 729 (88.1%) and 667 (80.7%) patients were alive at 12 and 24 months respectively. Median survival for non-resection patients was 4 months, with 108 (48.2%) and 84 (37.5%) patients alive at 12 and 24 months respectively, p < 0.0001 (Mann-Whitney U test). Median survival following surgical intervention for Stage IV disease was similar for major resection (12 months) or a palliative procedure (8 months).
During the 5 year period studied, the rate of non-resection remained constant at 22.7%, 21.9%, 22.9%, 22.8% and 24.5% year on year respectively, indicating that there was no change is selection criteria for major resection.
Conclusion To give a complete picture of a unit’s performance for colorectal cancer treatment, data on the rate of non-resection of CRC, together with an analysis of reasons for non-resection should be included in annual Unit or surgeon-specific outcome reports,. Major resection for Stage IV disease does not appear to offer any survival advantage over lesser, palliative procedures.
Disclosure of interest None Declared.
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