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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

Diseases of the Colon & Rectum: April 2014 - Volume 57 - Issue 4 - p 460–466
doi: 10.1097/DCR.0000000000000068
Original Contributions: Colorectal/Anal Neoplasia

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.

1Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands

2Department of Surgery, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands

3Department of Surgery, Deventer Hospital, Deventer, the Netherlands

Financial Disclosure: None reported.

Nicoline J. van Leersum and Arend G. Aalbers contributed equally to this article.

Correspondence: Nicoline J. van Leersum, M.D., Leiden University Medical Centre, Department of Surgery, K6-R, P.O. Box 9600, 2300 RC Leiden, the Netherlands. E-mail:

© 2014 The American Society of Colon and Rectal Surgeons