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Colorectal Cancer in the Young: Does the Extent of Resection Affect Outcomes?
Renelle J. Daigle*, Anthony R. Maclean, William D. Buie
Colorectal Surgery, University of Calgary, Calgary, AB, Canada
Patients aged 40 or younger who are diagnosed with colorectal cancer have additional years in which to develop metachronous cancers, and have a higher likelihood of having an underlying genetic mutation, causing some to advocate a more extensive resection in this group of patients. The purpose of this study was to examine the long term oncologic outcomes of CRC in patients diagnosed at age of 40 or younger. We also sought to compare the outcomes according to the type of resection performed (segmental versus extensive resection).
All patients ≤ 40 years old diagnosed with CRC from 2000-2011 within our health region were identified through the Provincial Cancer Board Registry. Patients with a diagnosis of ulcerative colitis, familial polyposis syndrome cancers other than adenocarcinoma, and those undergoing transanal or endoscopic excision were excluded. The patients'demographics, treatments and surveillance data were extracted from the patients charts and the electronic medical record.
75 patients met our inclusion criteria. The mean age was 35.5 and 53% were females. The majority of cancers were located in the right colon (40.0%) or rectum (35.0%). Emergency resection was required in 34.7% of patients. Thirty-nine (52%) of patients presented with stage III cancer. The majority of patients (62 patients) had symptoms on presentation with CRC. A segmental resection was performed in 80% of patients. The median follow-up was 65.5 months. During the study period, 23 patients developed metastatic disease. A total of 16 patients died of their disease at a mean of 39.5 months (range 5-77) post-operatively. During the follow-up period, 69.2% of patients were cancer-free. Loco-regional recurrence occurred in 5 patients, 4 of which had a segmental resection for their primary CRC, and all 5 of those patients had stage III CRC (p=0.30). Only one of those patients had resectable disease . No metachronous colon cancer or high risk colonic polyps were detected on.surveillance colonoscopies (SC). The interval for SC was variable (18.7% annual and 46.7% every 2-3 years). On univariate analysis, the overall survival (p=0.011) and local recurrence (p=0.017) were found to correlate with the extent of surgery. Distant metastasis (p=0.067) did not appear to be statistically significant on univariate analysis.
In this study, the majority of patient ≤ 40 years of age with CRC were symptomatic and had advanced stage cancer at presentation. They often required emergency resection which may have affected their prognosis. Despite the majority of patients having had segmental resections, there were no metachronous colon cancers identified. There was a higher risk of loco-regional recurrence and decreased overall survival in the segmental resection group.However, a segmental resection with close colonoscopic surveillance appears to be an acceptable treatment in this population.
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