Search

Background: The management of splenic flexure cancers (SFCs) in the era of complete mesocolic excision (CME) and central vascular ligation (CVL) is challenging because of its variable lymphatic drainage. This study aimed to compare survival outcomes for SFCs and non‐SFCs, and better understand the clinicopathological characteristics which may define a distinct SFC phenotype. Methods: An observational cohort study at Concord Hospital, Sydney was conducted with patients who underwent resection for colon adenocarcinoma (1995–2019). Clinicopathological data were extracted from a prospective database. Overall survival (OS) and disease‐free survival (DFS) estimates and their associations to clinicopathological variables were investigated with Kaplan–Meier and Cox regression analyses. Results: Of 2149 patients with colon cancer, 129 (6%) had an SFC. The overall 5‐year OS and DFS rates were 63.6% (95% CI 62.5–64.7) and 59.4% (95% CI 58.3–60.5), respectively. SFCs were not associated with OS (P = 0.6) or DFS (P = 0.5). SFCs were more likely to present urgently (P < 0.001) with obstruction (P < 0.001) or perforation (P = 0.03), and more likely to require an open operation (P < 0.001). These characteristics were associated with poorer survival outcomes. No differences were noted between SFCs and non‐SFCs with respect to tumour stage (P = 0.3). Conclusion: SFCs have a distinct phenotype, the individual characteristics of which are associated with poorer survival. However, the survivals of SFCs and non‐SFCs are similar, possibly because the most important determinant of outcome, tumour stage, is no different between the groups. This may have implications for the surgical approach to SFCs with respect to standardization of CME and CVL surgery for these cancers. [ABSTRACT FROM AUTHOR]

Backgrounds: Surgery remains mainstay management for colon cancer. Post‐operative anastomotic leak (AL) carries significant morbidity and mortality. Rates of, and risk factors associated with AL following right hemicolectomy remain poorly documented across Australia and New Zealand. This study examines the Bowel Cancer Outcomes Registry (BCOR) to address this. Methods: A retrospective cohort study was undertaken of consecutive BCOR‐registered right hemicolectomy patients undergoing resection for colon cancer (2007–2021). The primary outcome measure was AL incidence. Clinicopathological data were extracted from the BCOR. Factors associated with AL and primary anastomosis were identified using logistic regression. AL‐rate trends were assessed by linear regression. Results: Of 13 512 patients who had a right hemicolectomy (45.2% male, mean age 72.5 years, SD 12.1), 258 (2.0%) had an AL. On multivariate analysis, male sex (OR 1.33; 95% CI 1.03–1.71) and emergency surgery (OR 1.41; 95% CI 1.04–1.92) were associated with AL. Private health insurance status (OR 0.66; 95% CI 0.50–0.88) and minimally‐invasive surgery (OR 0.61; 95% CI 0.47–0.79) were protective for AL. Anastomotic technique (handsewn versus stapled) was not associated with AL (P = 0.84). Patients with higher ASA status (OR 0.47; 95% CI 0.39–0.58), advanced tumour stage (OR 0.56; 95% CI 0.50–0.63), and emergency surgery (OR 0.16; 95% CI 0.13–0.20) were less likely to have a primary anastomosis. AL‐rate and year of surgery showed no association (P = 0.521). Conclusion: The AL rate in Australia and New Zealand following right hemicolectomy is consistent with the published literature and was stable throughout the study period. Sex, emergency surgery, insurance status, and minimally invasive surgery are associated with AL incidence. [ABSTRACT FROM AUTHOR]

Background: While most colorectal cancer (CRC) recurrences reportedly occur within 3 years following curative treatment, many studies are limited by short‐term follow‐up. This study examines the time to recurrence of CRC in a large Australian cohort with a long follow‐up period and assesses whether time to recurrence has changed over time. Methods: A comprehensive prospective database of patients undergoing resection for CRC is maintained at Concord Hospital, Sydney. Demographic and time to recurrence data were extracted for patients who developed a recurrence following potentially curative resection for colon cancer from 1995 to 2010 and rectal cancer from 1971 to 2010. Non‐deceased patients had a minimum of 5 years follow‐up. Results: Between 1995 and 2010, 2575 patients with CRC underwent surgery. After exclusions, 386 had recurrence following potentially curative resection, ranging from 1 to 172.5 months (median 20.3) after treatment. Within 1 year, 27.5% recurred, 57.5% by 2 years, 74.6% by 3 years, 85.5% by 4 years and 89.6% by 5 years. There was no difference in time to recurrence between colon and rectal cancers (P = 0.674). Among patients having a potentially curative resection for rectal cancer between 1971 and 2010, 386 recurred. There was no difference in time to recurrence by decade (P = 0.863). Conclusion: The majority of recurrences occurred within 3 years of curative treatment. Had surveillance been limited to 5 years, detection of more than 10% of recurrences would have been delayed. Time to recurrence for rectal cancer has not changed in over 40 years, despite treatment advances. [ABSTRACT FROM AUTHOR]

Background To our knowledge, immediate post-operative complication rates after resection of colorectal cancer ( CRC) have not been compared between public and private hospitals in the Australian health care system. We compared the frequency of surgical and medical complications between a public tertiary referral hospital and a private hospital. Methods Data were drawn from a prospective registry of all patients having a resection for CRC between 2000 and 2010 performed by members of the Concord Hospital colorectal surgical unit, either at this hospital or at a single private hospital with which they were affiliated. Complication rates were compared after adjustment for preoperative and perioperative features by logistic regression. Results Among the 16 surgical complications, the only significant difference after adjustment for other features was a higher rate of septicaemia in the public hospital (odds ratio ( OR) 2.2, 95% confidence interval ( CI) 1.1-4.6). Among the seven medical complications, the only significant differences were a higher risk of cardiac complications in patients with cardiac co-morbidity ( OR 1.8, 95% CI 1.1-3.0) and of respiratory complications in patients without respiratory co-morbidity ( OR 3.1, 95% CI 2.2-5.9) in the public hospital. Conclusion In this study, where the same group of surgeons performed all reported CRC resections in the two hospitals, no independent effect of the type of hospital was found on 15 of 16 surgical complications and 5 of 7 medical complications. Type of hospital had no impact on rates of specific complications apart from septicaemia and cardiorespiratory complications, which were higher in the public hospital. [ABSTRACT FROM AUTHOR]

The aim of this study was to identify independent background and perioperative risk factors for prolonged postoperative hospital stay among patients having a resection for colorectal cancer. Data from 1095 consecutive resections performed by specialist colorectal surgeons between 1995 and 2001 were examined by multiple least squares regression. Each putative risk factor was coded 0 if absent and 1 if present and postoperative stay was measured in days, so that the unstandardized partial regression coefficients (B) represent days of additional stay if the factor was present. Confidence intervals are at the 95% level. Of 35 factors examined, the following 11 had a significant independent association with postoperative stay: urgent operation (B = 4.2, CI 2.2−6.2); preoperative stay>5 days (B = 4.2, CI 2.7−5.7); perioperative transfusion (B = 3.1, CI 2.2−4.2); adjacent organ or structure involved (B = 3.0, CI 1.2−4.9); stoma constructed (B = 2.6, CI 1.8−3.5); peripheral vascular disease (B = 2.3, CI 0.4−4.1); age ≥75 years (B = 2.2, CI 1.2−3.1); respiratory disease (B = 1.7, CI 0.5−2.8); American Society of Anesthetists’ (ASA) classification>Class 2 (B = 1.5, CI 0.4−2.5); splenic flexure mobilized (B = 1.4, CI 0.5−2.3); private hospital (B = 1.4, CI 0.3−2.5). Together these factors accounted for only a fifth of the variability in length of stay and few, except possibly ASA, were susceptible of interventions that might reduce stay. Postoperative morbidity, which is largely unpredictable, remains the major cause of prolonged hospital stay. [ABSTRACT FROM AUTHOR]