Screening-detected colorectal cancers may have superior surgical outcomes

When comparing post-operative 90-day mortality with surgical and non-surgical outcomes, patients whose colorectal cancer (CRC) was found in the Danish screening programme were at a surgical advantage. However, looking at the subgroups according to Union for International Cancer Control (UICC) stages, benefits were only present in UICC 3 and 4.

Denmark has implemented a screening programme for CRC [1]. “We know that it leads to a lower stage at the time of diagnosis, but current evidence is sparse and not agreeing on the effect on the surgical outcome,” Dr Jannie Dressler (Bispebjerg Hospital, Denmark) explained the reason for the retrospective, nationwide, register-based cohort study. The analysis evaluated the potential differences in risks involved for patients who were diagnosed with CRC between January 2014 and March 2018.

The study cohort included 10,606 adults aged 50–75 years who received surgery for their CRC. Among them were 4,497 participants whose diagnosis was detected through screening (SD-CRC) and 6,109 who did not partake in the programme (NSD-CRC). The 2 groups were significantly heterogenic in numerous disease and tumour-related factors. The analysis was adjusted for 5-year age groups, sex, cancer type, and Charlson comorbidity index.

Significant outcomes in favour of the SD-CRC group were detected for surgical as well as non-surgical complications (both P<0.0001). SD-CRC participants received significantly fewer blood transfusions, had fewer tumour perforations, their time in hospital was shorter, and the 90-day mortality rate was lower than in the NSD-CRC group (P<0.0001 for all comparisons).

The picture changed regarding the 90-day mortality rate, surgical complications, and non-surgical complications after stratification according to UICC stages of the CRC. In UICC stages 1 and 2, the differences were no longer significant. In UICC 3, the outcomes for 90-day mortality and surgical complications remained significantly different (P=0.029 and P=0.005). In UICC 4, this was the case for non-surgical complications in addition to the 90-day mortality rate (P=0.020 and P<0.0001).

Dr Dressler stressed that these findings are important for various reasons, including as argument for the continuation and improvement of the CRC screening programme, for better participation rates, and also for CRC screening programme implementation in other countries. “And it is really important when you want to inform your patient about the prognosis,” she finally underlined in her conclusion.

1. Dressler J, et al. The effects of the Danish colorectal cancer screening program on intra-/post-operative complications and duration [sic] hospital stay after surgery for colorectal cancer: a retrospective cohort study. OP004, UEG Week 2022, 8–11 October, Vienna, Austria.

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Posted on 2 December, 2022