Background: Colorectal cancer is the third most common cause of cancer and the second most common cause of cancer death among Canadian men and women. In 2007, an estimated 8,129 persons in Ontario, Canada will be diagnosed with colorectal cancer and 2,793 will die from this disease. Surgical treatment is the cornerstone of the management of colorectal cancer; however there are few population-based reports of patterns of treatment. Laparoscopic colorectal surgery is also changing the surgical approach to the treatment of colorectal cancer. We used a population-based cancer registry and administrative health data to describe patterns of the surgical treatment of colon cancer in Ontario in the period 2003-2004.
Methods: We linked data from administrative health databases (Canadian Institute for Health Information [CIHI] and the Ontario Health Insurance Plan [OHIP]) to a population-based cancer registry (the Ontario Cancer Registry [OCR]) to measure hospitalizations and surgical treatment received by all patients with a new diagnosis of colon cancer in Ontario from March 1 2003 to April 30 2004.
Results: During this 1 year period, 5265 residents of Ontario were newly diagnosed with primary colon cancer. Of these, 50.9% were men and 20.3% were aged less than 60 years. 91.2% of all patients had a surgical procedure. Among persons aged less than 60 years, 1.3% (95% confidence interval [95% CI] 0.5-1.9) had a resection with a permanent stoma, 11.9% (95% CI 9.9-14) had a resection with creation of a reversible stoma, 69.1% (95% CI 66.2-71.9) had a resection with primary anastomosis and 17.8% (95% CI 15.4-20.1) had an “other” surgical procedure (intestinal bypass, local excision or other abdominal procedure). Among persons older than 60 years, 1.1% (95% CI 0.8-1.4) had a resection with a permanent stoma, 11.5% (95% CI 10.5-12.6) had a resection with creation of a reversible stoma, 70.7% (95% CI 69.3-72.1) had a resection with primary anastomosis and 16.7% (95% CI 15.5-17) had an “other” surgical procedure. 354 (7.4%) of all cases were done laparoscopically. Among persons aged <60 years, 8.8% (95% CI 7.1-10.6) had laparoscopic surgery compared to 7% (95% CI 6.2-7.8) in the older group (p for difference = 0.047). There was no difference in the rate of laparoscopic procedures between men and women.
Conclusions: The majority of patients newly diagnosed with colon cancer in Ontario undergo resection without creation of a stoma. There was no significant difference in rates of the different types of surgery received according to age. Less than 10% of operations were done laparoscopically and younger patients were more likely to undergo laparoscopic procedures.