Objective:To examine the clinical utility of improved detection of venous invasion (VI) in patients undergoing potentially curative resection of colorectal cancer.Background:VI is a feature of colorectal cancer (CRC) progression. Elastica staining can be used to improve detection of VI and correspon

The clinical utility of the combination of T stage and venous invasion to predict survival in patients undergoing surgery for colorectal cancer.

Population colorectal cancer screening programmes have been introduced to reduce cancer-specific mortality through the detection of early-stage disease. The present study aimed to examine the impact of screening introduction in the West of Scotland. Data on all patients with a diagnosis of colorectal cancer between January 2003 and December 2012 were extracted from a prospectively maintained regional audit database. Changes in mode, site and stage of presentation before, during and after screening introduction were examined. In a population of 2.4 million, over a 10-year period, 14 487 incident cases of colorectal cancer were noted. Of these, 7827 (54%) were males and 7727 (53%) were socioeconomically deprived. In the postscreening era, 18% were diagnosed via the screening programme. There was a reduction in both emergency presentation (20% prescreening vs 13% postscreening, P⩽0.001) and the proportion of rectal cancers (34% prescreening vs 31% pos-screening, P⩽0.001) over the timeframe. Within non-metastatic disease, an increase in the proportion of stage I tumours at diagnosis was noted (17% prescreening vs 28% postscreening, P⩽0.001). Within non-metastatic disease, a shift towards earlier stage at diagnosis has accompanied the introduction of a national screening programme. Such a change should lead to improved outcomes in patients with colorectal cancer.

/pdf/temporal-trends-in-mode-site-and-stage-of-presentation-with-4iryyhaurs.pdf

Temporal trends in mode, site and stage of presentation with the introduction of colorectal cancer screening: a decade of experience from the West of Scotland.

Colorectal cancer remains a significant cause of morbidity and mortality, even despite curative treatment. A significant proportion of patients present emergently and have poorer outcomes compared to elective presentations, independent of TNM stage. In this systematic review and meta-analysis, differences between elective/emergency presentations of colorectal cancer were examined to determine which factors were associated with emergency presentation. A literature search was carried out from 1990 to 2018 comparing elective and emergency presentations of colon and/or rectal cancer. All reported clinicopathological variables were extracted from identified studies. Variables were analysed through either systematic review or, if appropriate, meta-analysis. This study identified multiple differences between elective and emergency presentations of colorectal cancer. On meta-analysis, emergency presentations were associated with more advanced tumour stage, both overall (OR 2.05) and T/N/M/ subclassification (OR 2.56/1.59/1.75), more: lymphovascular invasion (OR 1.76), vascular invasion (OR 1.92), perineural invasion (OR 1.89), and ASA (OR 1.83). Emergencies were more likely to be of ethnic minority (OR 1.58). There are multiple tumour/host factors that differ between elective and emergency presentations of colorectal cancer. Further work is required to determine which of these factors are independently associated with emergency presentation and subsequently which factors have the most significant effect on outcomes. 

/pdf/determinants-of-emergency-presentation-in-patients-with-31fuo92x.pdf

Determinants of emergency presentation in patients with colorectal cancer: a systematic review and meta-analysis

Aim: To investigate the influence of a screening program on the
short-term outcome of patients undergoing surgery for colorectal
cancer.
Methods: Between April 2010 and December 2012 patients
diagnosed with colorectal cancer via the screening program (n = 80)
were compared with patients diagnosed elsewhere (n = 106). Only
patients of ≥ 50 and ≤ 69 years of age diagnosed outside the program
were selected as controls. The clinical variables included age,
sex, American Society of Anesthesiologists (ASA) status, Charlson
index, preoperative hemoglobin and serum albumin levels, surgical
approach, tumor location and stage, perioperative transfusion and
postoperative morbidity. A multivariate analysis was used to identify
variables independently associated with outcome.
Results: There were no significant differences with regard to
age, sex and ASA status. Preoperative hemoglobin (14.1 ± 1.6 g/
dl vs 12.3 ± 2.3 g/dl; p < 0.001) and serum albumin (4.45 ± 0.26
g/dl vs 4.0 ± 0.6 g/dl; p < 0.001) levels were significantly higher in
the screening group. The overall morbidity was significantly lower
in the screening group (38.8% vs 63.2; p < 0.001) and mainly
related to a higher rate of Clavien-Dindo grade II complications in
controls. There were no differences with regard to wound infection,
postoperative ileus, anastomotic leakage or reoperations. The
median length of hospital stay was shorter in the screening group
(6 vs 9 days; p = 0.003). Multivariate analysis showed that diagnosis
outside the screening program, type of surgical procedure,
open surgery and Charlson index were independent risk factors for
postoperative complications.
Conclusions: The diagnosis of colorectal cancer via the
screening program is associated with a lower rate of postoperative
minor complications and a shorter hospital stay.

/pdf/the-impact-of-screening-on-short-term-outcome-after-surgery-2xpv8korqp.pdf

The impact of screening on short-term outcome after surgery for colorectal cancer

Aim
In addition to TNM stage, there are adverse tumour and host factors, such as venous invasion and the presence of an elevated systemic inflammatory response (SIR) that influence the outcome in colorectal cancer. The present study aimed to examine how these factors varied in screen detected (SD) and non-screen detected tumours (NSD).

Method
Prospectively maintained databases of the prevalence round of a biennial population FOBt screening programme and a regional cancer audit database were analysed. Interval cancers (INT) were defined as cancers identified within two years of a negative screening test.

Results
Of the 395 097 invited, 204 535 (52%) responded, 6159 (3%) tested positive, and 421 (9%) had cancer detected. From this cohort, a further 708 (63%) NSD patients were identified (468 (65%) non-responders, 182 (25%) INT cancers and 58 (10%) did not attend or did not have cancer diagnosed at colonoscopy). Comparing SD and NSD patients, SD patients were more likely to be male, and have a tumour with a lower Dukes stage (both p<0.05). On stage-by-stage analysis, SD patients had less evidence of an elevated SIR (p<0.05). Both the presence of venous invasion (p=0.761) and an elevated SIR (p=0.059) were similar between those with INT cancers and in those that arose in non-responders.

Conclusion
Independent of TNM stage, SD tumours have more favourable host prognostic factors than NSD tumours. There is no evidence that INT cancers are biologically more aggressive than those that develop in the rest of the population and hence are likely to be due to limitations of screening in its current format.

This article is protected by copyright. All rights reserved.

/pdf/a-comparison-of-tumour-and-host-prognostic-factors-in-screen-3ux4ht02p1.pdf

A comparison of tumour and host prognostic factors in screen-detected vs nonscreen-detected colorectal cancer: a contemporaneous study.

Aim Bowel screening aims to reduce colorectal-cancer mortality by the detection and treatment of early-stage asymptomatic disease and the removal of precancerous adenomas. Bowel screening started in Ayrshire and Arran in September 2007. We report the impact of this screening on the diagnosis and stage of colorectal cancer and characterize screen-detected cancers in comparison with those diagnosed through other pathways.



Method  Diagnoses were identified from an audit database. Referrals were grouped into screen detected, routine, urgent and emergency presentations.



Results  Between January 2001 and December 2010, 2289 diagnoses of colorectal cancer were made. From 2001 to 2006, the mean (range) number of new colorectal-cancer diagnoses per year was 210 (198–220). Between 2007 and 2010, the mean (range) number of diagnoses per year was 256 (239–274), a significant (P = 0.008) increase. Since September 2007, 877 colorectal cancers have been diagnosed: 17% were screen detected; 11% were detected as a result of routine GP referral; 51% were detected after urgent GP referral; and 21% were emergency presentations. TNM stage increased with urgency of referral. Approximately two-thirds (66%) of screen-detected colorectal cancers were node negative vs 25% of emergency presentations (P < 0.001). Most screen-detected cancers were distal to the splenic flexure (75%). Screened cancers had favourable pathology; lower T and N stages (both P < 0.001), less venous invasion (P < 0.001) and better differentiation (P < 0.05). Similar results were seen after stratification for TNM stage. Screening has not yet resulted in a significant shift towards early-stage disease since 2007.



Conclusion  Screening has been associated with an increase in the numbers of both new and early-stage colorectal cancers. Screen-detected cancers are predominantly early-stage disease with favourable pathology. At present, it remains to be seen whether screening will ultimately translate into an overall reduction in advanced-stage disease.

Impact of the bowel-screening programme on the diagnosis of colorectal cancer in Ayrshire and Arran

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Impact of the bowel-screening programme on the diagnosis of colorectal cancer in Ayrshire and Arran