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Original Investigation
December 19, 2018

Postoperative Outcomes of Screen-Detected vs Non–Screen-Detected Colorectal Cancer in the Netherlands

Author Affiliations
  • 1Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
  • 2Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands
  • 3Scientific Bureau of the Dutch Institute of Clinical Auditing, Leiden, the Netherlands
  • 4Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
  • 5Department of Surgical Oncology, the Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
  • 6Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
JAMA Surg. 2018;153(12):e183567. doi:10.1001/jamasurg.2018.3567
Key Points

Question  Do patients referred through the fecal immunochemical test–based colorectal cancer screening program have better surgical outcomes compared with non–screen-detected patients?

Findings  In this population-based cohor study of 18 826 patients, those with screen-detected colon cancer had significantly lower odds on different postoperative complications, even when extensive case-mix adjustment is performed.

Meaning  Future studies on surgical outcomes of colorectal cancer treatment should be aware of the differences between patients detected through the screening program and non–screen-detected patients and consequently take this into account in their comparison models.

Abstract

Importance  The nationwide fecal immunochemical test–based screening program has influenced surgical care for patients with colorectal cancer (CRC) in the Netherlands, although these implications have not been studied in much detail so far.

Objective  To compare surgical outcomes of patients diagnosed as having CRC through the fecal immunochemical test–based screening program (screen detected) and patients with non–screen-detected CRC.

Design, Setting, and Participants  This was a population-based comparative cohort study using the Dutch ColoRectal Audit and analyzed all Dutch hospitals performing CRC resections. Patients who underwent elective resection for CRC between January 2011 to December 2016 were included.

Interventions  Colorectal cancer surgery.

Main Outcomes and Measures  Postoperative nonsurgical complications, postoperative surgical complications, postoperative 30-day or in-hospital mortality, and complicated course (postoperative complication resulting in a hospital stay >14 days and/or a reintervention and/or mortality). A risk-stratified comparison was made for different postoperative outcomes based on screening status (screen detected vs not screen detected), cancer stage (I-IV), and for cancer stage I to III also on age (aged ≤70 years and >70 years) and American Society of Anesthesiologists score (I-II and III-IV). To determine any residual case-mix–corrected differences in outcomes between patients with screen-detected and non–screen-detected cancer, univariable and multivariable logistic regression analyses were performed.

Results  In total, 36 242 patients with colon cancer and 17 416 patients with rectal cancer were included for analysis. Compared with patients with non–screen-detected CRC, screen-detected patients were younger (mean [SD] age, 68 [5] vs 70 [11] years), more often men (3777 [60%] vs 13 506 [57%]), and had lower American Society of Anesthesiologists score (American Society of Anesthesiologists score III+: 838 [13%] vs 5529 [23%]). Patients with stage I to III colon cancer who were screen detected had a significantly lower mortality and complicated course rate compared with non–screen-detected patients. For patients with rectal cancer, only a significant difference was found in mortality rate in patients with a cancer stage IV disease, which was higher in the screen-detected group. Compared with non–screen-detected colon cancer, an independent association was found for screen-detected colon cancer on nonsurgical complications (adjusted odds ratio, 0.81; 95% CI, 0.73-0.91), surgical complications (adjusted odds ratio, 0.80; 95% CI, 0.72-0.89), and complicated course (adjusted odds ratio, 0.80; 95% CI, 0.71-0.90). Screen-detected rectal cancer had significantly higher odds on mortality.

Conclusions and Relevance  Postoperative outcomes were significantly better for patients with colon cancer referred through the fecal immunochemical test–based screening program compared with non–screen-detected patients. These differences were not found in patients with rectal cancer. The outcomes of patients with screen-detected colon cancer were still better after an extensive case-mix correction, implying additional underlying factors favoring patients referred for surgery through the screening program.

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