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RECTAL CANCER IN THE YOUNG; ANALYSIS OF CONTRIBUTING FACTORS
Odinaka P. Mogor2, Agnes N. Ewongwo2, Pamela Omesiete2, Viraj Pandit2, Kelvin Memeh2, Debbie Chen2, Valentine Nfonsam*1
1Colon and Rectal Surgery, The University of Arizoma, Tucson, AZ; 2The University of Arizona, Tucson, AZ
INTRODUCTION: The overall incidence of rectal cancer (RC) has steadily declined but RC among young patients (≤ 50 years) is on the rise. The factors associated with development of RC are established. However, factors leading to the development of early RC remain unclear. The aim of this study was to assess factors associated with RC among young patients
METHODS: National estimates for patients with rectal cancer were abstracted from the National Inpatient Sample (NIS) database (2010-2012). Patient were divided into: Young (≤ 50yrs) and old (>50yrs). Patients demographic, comorbidities, procedures performed, and hospital outcomes were collected. Statistical analysis was performed to compare the two main groups.
RESULTS: A total of 68,699 patients with rectal cancer were included in the study. Mean age was 65.3±15 of which 4% were young. Incidence of rectal among young patients increased significantly over the study period (2.8% vs 3% vs 3.4%; p=0.04). Majority of the young patients with RC were white female. Bleeding was the most common presentation among young patients (p=0.03). Younger patients were more likely to have a family history of rectal cancer (p=0.01) and were more likely to undergo elective surgery (p=0.04) and laparoscopic surgery (p=0.02) compared to the older patients. Younger patients with RC were more likely to use alcohol (p=0.03), and be obese (p=0.02) compared to older patients. There were no differences in other co-morbidities between the two groups. After controlling for all factors in a regression model, younger patients had a lower complication rate (p=0.01), hospital LOS (p=0.02), and mortality rate (p=0.04).
CONCLUSION: Majority of patients with rectal cancer are above age 50. Variations in presentation, demographics and comorbidities exits between younger and older patients with RC. Even though younger patients with RC have more aggressive disease, their overall mortality is lower. Understanding the molecular and genetic reasons for these differences may help improve care among younger patients with rectal cancer.
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