Diseases of the Colon & Rectum

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Diseases of the Colon & Rectum:
doi: 10.1097/DCR.0000000000000068
Original Contributions: Colorectal/Anal Neoplasia

Synchronous Colorectal Carcinoma: A Risk Factor in Colorectal Cancer Surgery

van Leersum, Nicoline J. M.D.1; Aalbers, Arend G. M.D.2; Snijders, Heleen S. M.D.1; Henneman, Daniel M.D.1; Wouters, Michel W. M.D., Ph.D.1,2; Tollenaar, Rob A. M.D., Ph.D.1; Eddes, Eric Hans M.D., PhD.3

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BACKGROUND: Synchronous colorectal carcinoma occurs in 1% to 8% of cases. There are little data on the impact of synchronous colorectal cancer on surgical treatment and short-term postoperative outcomes.

OBJECTIVE: The purpose of this work was to evaluate clinical characteristics and treatment patterns of synchronous colorectal carcinoma and their influence on short-term postoperative outcomes in comparison with solitary colorectal carcinoma.

DESIGN: This was a population-based observational study. Patient and tumor characteristics, treatment patterns, and postoperative outcomes are described for patients with a solitary and synchronous colorectal carcinoma separately. Multivariable logistic regression analysis was used to analyze the association between synchronous colorectal carcinoma and postoperative complications in comparison with a solitary colorectal carcinoma.

SETTINGS: The study included in-hospital registration for the Dutch Surgical Colorectal Audit.

PATIENTS: Patients were those with primary colorectal carcinoma from 2009 to 2011.

MAIN OUTCOME MEASURES: Severe postoperative complications, reinterventions, and 30-day mortality were measured.

RESULTS: Of 25,413 patients with colorectal cancer, 884 (3.5%) had synchronous colorectal tumors. Patients with synchronous colorectal carcinoma were older and more often of male sex compared with patients with solitary colorectal carcinoma. In ≥35% of cases, an extended surgical procedure was conducted (n = 310). In multivariable logistic regression analysis, synchronous colorectal carcinoma was associated with a higher risk of severe postoperative complications (OR, 1.40; 95% CI, 1.20–1.63) and reinterventions (OR, 1.37; 95% CI, 1.14–1.65) compared with solitary colorectal carcinoma but not with higher 30-day mortality (OR, 1.34; 95% CI, 0.96–1.88).

LIMITATIONS: This study was limited by the data being self-reported. Case-mix adjustment was limited to information available in the data set, and no long-term outcome data were available.

CONCLUSIONS: Synchronous colorectal carcinomas are prevalent in 3.5% of patients and require a different treatment strategy in comparison with solitary colorectal carcinoma. Postoperative outcomes are unfavorable, most likely because of extensive surgery.

© 2014 The American Society of Colon and Rectal Surgeons


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