Michael P.M. de Neree tot Babberich, MD
In a Dutch study reported in JAMA Surgery, Michael P.M. de Neree tot Babberich, MD, of the Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, and colleagues found that postoperative outcomes were better in patients with colon cancer, but not rectal cancer, detected vs not detected through the national fecal immunochemical test–based screening program.
The study included comparison of outcomes between screening-detected and nonscreening-detected patients undergoing resection at Dutch hospitals after initiation of the screening program during 2014 to 2016. Among patients with colon cancer, disease was screening-detected in 4,696 and nonscreening-detected in 15,936. Among those with rectal cancer, disease was screening-detected in 1,582 and nonscreening-detected in 7,936. To adjust for differences in case mix, factors in multivariate analysis included age, sex, body mass index, American Society of Anesthesiologists score, Charlson comorbidity score, any tumor-related complication, previous abdominal surgery, pathologic tumor classification, presence of metastasis, additional resection due to tumor invasion, additional resection due to metastasis, and other factors specific to colon or rectal disease.
Rates of Complications
On multivariate analysis, among patients with colon cancer, screening-detected patients had significantly lower rates of nonsurgical postoperative complications (11.8% vs 18.5%, odds ratio [OR] = 0.81, 95% confidence interval [CI] = 0.73–0.91), surgical postoperative complications (12.0% vs 17.0%, OR = 0.80, 95% CI = 0.72–0.89), and complicated course (9.2% vs 14.4%, OR = 0.80, 95% CI = 0.71–0.90), with no significant difference in mortality (0.6% vs 1.9%, OR = 0.74, 95% CI = 0.49–1.12).
Among patients with rectal cancer, no significant differences for screening-detected vs nonscreening-detected patients were observed for nonsurgical postoperative complications (18.5% vs 21.8%, OR = 0.99, 95% CI = 0.85–1.15), surgical postoperative complications (20.4% vs 23.1%, OR = 0.99, 95% CI = 0.86–1.15), or complicated course (17.2% vs 19.2%, OR = 1.03, 95% CI = 0.88–1.21); risk for mortality was higher among screen-detected patients (1.2% vs 1.0%, OR = 2.27, 95% CI = 1.31–3.96).
The investigators concluded, “Postoperative outcomes were significantly better for patients with colon cancer referred through the fecal immunochemical test–based screening program compared with [nonscreening]-detected patients. These differences were not found in patients with rectal cancer. The outcomes of patients with [screening]-detected colon cancer were still better after an extensive case-mix correction, implying additional underlying factors favoring patients referred for surgery through the screening program.” ■