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Prognosis of colon cancer compared with rectal cancer. Where lies the difference?

Bjørn S. Nedrebø Stavanger University Hospital. Prognosis of colon cancer compared with rectal cancer. Where lies the difference?. Aim of the lecture. Compare colon and rectal cancer in Norway Point out differences, short term and long term

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Prognosis of colon cancer compared with rectal cancer. Where lies the difference?

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  1. Bjørn S. Nedrebø Stavanger University Hospital Prognosis of colon cancer compared with rectal cancer. Where lies the difference?

  2. Aim of the lecture • Compare colon and rectal cancer in Norway • Point out differences, short term and long term • Quality of the surgical specimen of colon cancers in Norway

  3. ColorectalCancer in Norway EvolutionofTreatmentRecommendations Rectal Cancer National Registry Introduction TME Rx T4, fixed MRI staging CRM ≤3 mm MDT 1993/94 1997 2000 2003 Cx Stage III ≤75 yrs Colon Cancer 3

  4. Patient Cohort Norwegian Cancer Registry & Rectal Cancer Registry, 1994 – 2003 N=31158 (100%) Metachronous cancer; n=1486 (5%) N=29672( 95%) Metastases; n=9024 (29%) N=20648 (66%) Minor resections; N=1595 (5%) Study population N=19053 (61%)

  5. Method • 5 year relative survival for all patients • Excess mortality in different timeperiods • Time periods (1) 1994-1996 (N=5400) (2) 2001-2003 (N=5870) 70% Colon cancer in both periods

  6. Analysis • Localisation • Rectum (≤ 15 cm from anal verge) • Colon • Stage • N0 (T1-4,N0) • N+ (T1-4, N1-2) • Age: <75 vs. ≥75 year

  7. Patient Characteristics

  8. Improved survivalColon and rectal cancer 1994-1996 2001-2003 Colon Rektum p<0.01 p<0.01

  9. Fig 1 a-b: Early studyperiod vs late studyperiod 1a Colon cancer 1b Rectal cancer

  10. Colon vs rectum Colon Rectum Early period Late period p<0.03 p<0.74

  11. Fig 2 a-b. Coloncancer vs rectumcancer 2b Late period 2a Early period

  12. Colon early vs late 1994-1996 2001-2003 N+ N0

  13. Rectal cancer, early vs late 1994-1996 2001-2003 N0 N+

  14. N+

  15. Lymph node sampling as a proxy of surgical technique • Included all patients in Norway 2007-2008 who were operated for adenocarcinoma in colon • Lymph node sampling; % operations with ≥12 lymph nodes. • 5068 coloncancer (100%) • 4145 (81%) underwent surgical resection. • 3733 patients (73%) with complete histopathologydata • 73% ≥ 12 lymph nodes • 16% laparoscopy

  16. Age

  17. Sex/localisation

  18. Hospital volume

  19. Elective vs acute

  20. Multivariatanalyse • ≥12 lymph nodes: • Pasient <70 years • Elective surgery • High volume hospital • pT >1 • Right sided resection • Pathological template

  21. Conclusion Better survival for rectal cancer than colon cancer Need to focus on colon cancer, especially patients over 75 years acute surgery high volume hospitals(?) standardised pathology template

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