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DIFFERENCES IN DEMOGRAPHIC, CHARACTERISTICS, AND SURGICAL OUTCOMES OF PATIENTS WITH YOUNG ONSET COLORECTAL CANCER: A COMPARATIVE ANALYSIS
Seyed Ali Mousavi Almaleki
*, Gloria Chang, Javier Salgado Pogacnik, Emina Huang, Sitaram Chilakamarry, lai xue, Laindy Liu, alessandra storino gonzalez, Amudhan Kannan, Fadwa Ali
The University of Texas Southwestern Medical Center, Dallas, TX
Background:
Colon cancer is a leading cause of cancer-related mortality worldwide, and the incidence is rising in patients younger than 50 years of age. This population is vulnerable due to limitations of screening, and symptoms can often go unrecognized. Specific details regarding the demographics, biology, and surgical outcomes of young onset colorectal cancer remain unknown. We aim to compare demographics, characteristics, and surgical outcomes of patients with young onset colon cancer compared to average/late onset.
Methods:
We queried the colorectal surgery participant user data file in the NSQIP from 2014-2022 and the National Cancer Database (NCDB) from 2011-2021 to evaluate patients diagnosed with colon cancer. Patients who underwent colectomies for colon cancer were identified based on CPT and ICD-10 codes and categorized into two groups: patients < 50 and ? 50 years old. The endpoint was to assess differences in demographics, and characteristics (NCDB), operative approach, and 30-day postoperative outcomes (NSQIP).
Results:
A total of 782,728 patients from NCDB and 150,508 patients From NSQIP were included. Of these, 99,651 (10.7%) were < 50, and 833,585 (89.3%) were ? 50. 68,531 patients (7.3%) of all and (69%) of young patients were between 40-49 years old. The incidence of colon cancer in white patients was significantly higher in older patients (77.4% vs.66.4%; p<.001). Among other racial groups, colon cancer was significantly more common in younger patients: African Americans (15.9%vs.12.6%; p<.001), and Hispanics (11.4%vs.5.8%; p<.001). Older patients had a significantly higher incidence in the right and transverse colon (51.5%vs.43% and 10%vs.7.1%; p<.001), while younger patients had a significantly higher incidence of left-sided lesions (44%vs.32.7%; p<.001). Patients with young onset were more likely to present with stage III and stage IV disease (28.9%vs.25.9% and 3.4%vs.2.0%; p<.001) respectively, and were more likely to undergo emergency surgery (10.2%vs.8.9%; p<.001) and ostomy creation (15%vs.9.6%; p<.001). There was no significant difference in the use of open or minimally invasive surgery. The incidence of reoperation, readmission, Superficial and deep surgical site infections was similar between the two groups, but younger patients had a higher incidence of organ infections related to surgery (4.5%vs.3.6%; p<.001) and sepsis (3.3%vs.2.6%; p<.001).
Conclusions:
The incidence of colon cancer in younger patients is rising. Younger patients tend to have left-sided lesions and more advanced-stage disease. As a result, they tend to require more surgical intervention in the emergency setting and more creation of an ostomy compared to older patients. More efforts should be placed in early diagnosis/ screening for colon cancer in patients between 40-50 years of age, especially in patients from African American or Hispanic ethnicities.
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