Society for Surgery of the Alimentary Tract
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Swati Sonal*1,2, Hiroko Kunitake1,2, Robert N. Goldstone1,2, Liliana G. Bordeianou1,2, Christy E. Cauley1,2, Todd D. Francone3, Rocco Ricciardi1,2, David L. Berger1,2
1Massachusetts General Hospital, Boston, MA; 2Harvard University, Cambridge, MA; 3Newton-Wellesley Hospital, Newton, MA

Mortality due to Colorectal cancer (CRC) continues to decline with advancements in screening and management strategies. However, CRC remains the third leading cause of cancer-related mortality in the United States. In this study, we evaluated the causes of death in patients operated for CRC and the characteristics that might predict death due to CRC versus other causes.

An IRB-approved database containing patients who underwent surgical resection for CRC from 2004-2018 (last followed up in December 2020) in a tertiary care institution was used for the study. Data on the underlying cause of death of these individuals was extracted from the Registry of Vital Records & Statistics. Multivariate analysis was performed using a logistic regression model.

A total of 576 deaths were recorded in the database, of which 290 (50.35%) patients died of CRC, followed by other cancers (85, 14.76%), cardiovascular disease (75, 13.02%), neurological disease (30, 5.21%), pulmonary disease (30, 5.21%), infection (25, 4.34%), kidney disease (16, 2.78%), gastrointestinal disease (7, 1.21%), and other causes (18, 3.12%). Deaths from CRC gradually decreased over time, while deaths from other cancers increased, and deaths from cardiovascular diseases remained stable (Figure 1). Patients who died from CRC were younger at diagnosis, died earlier in the disease course, had fewer comorbidities, higher TNM stages, higher rates of rectal cancer, extramural vascular invasion (EMVI), perineural invasion, R0 resection, and preserved mismatch repair protein (MMR) status. On multivariate analysis, age (aOR=0.97, 95%CI 0.95-0.99), American Society of Anesthesiologists (ASA) score (aOR=0.65, 0.42-0.99), stage IV disease (aOR=4.37, 2.18-8.94), EMVI (aOR=1.95, 1.14-3.34) & time from diagnosis to death (aOR=0.76, 0.69-0.83) predicted death due to CRC versus other causes, while tumor location (aOR=1.82, 0.97-3.5), perineural invasion (aOR=1.48, 0.85-2.58), R0 resection (aOR=0.34, 0.09-1.07), & MMR status (aOR=1.59, 0.9-2.82) did not.

More than 50% of patients operated for CRC died of CRC. There was a declining trend of deaths from CRC presumably reflecting advances in CRC management strategies and better screening over time. However, this was counteracted by a rising trend of deaths due to secondary cancers. Younger patients with fewer comorbidities, metastatic disease, and EMVI at presentation disproportionately contribute to death due to CRC.

Figure 1: Time trend of causes of death

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