Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands.
Colorectal Dis. 2018 Sep;20(9):O239-O247. doi: 10.1111/codi.14313. Epub 2018 Jul 16.
In 2014, a national colorectal cancer (CRC) screening programme was launched in the Netherlands. It is difficult to assess for the individual patients with CRC whether the oncological benefits of surgery will outweigh the morbidity of the procedure, especially in early lesions. This study compares patient and tumour characteristics between screen-detected and nonscreen-detected patients. Also, we present an overview of treatment options and clinical dilemmas when treating patients with early-stage colorectal disease.
Between January 2014 and December 2016, all patients with nonmalignant polyps or CRC who were referred to the Department of Surgery of the Leiden University Medical Centre in the Netherlands were included. Baseline characteristics, type of treatment and short-term outcomes of patients with screen-detected and nonscreen-detected colorectal tumours were compared.
A total of 426 patients were included, of whom 240 (56.3%) were identified by screening. Nonscreen-detected patients more often had comorbidity (P = 0.03), the primary tumour was more often located in the rectum (P = 0.001) and there was a higher rate of metastatic disease (P < 0.001). Of 354 surgically treated patients, postoperative adverse events did not significantly differ between the two groups (P = 0.38). Of 46 patients with T1 CRC in the endoscopic resection specimen, 23 underwent surgical resection of whom only 30.4% had residual invasive disease at colectomy.
Despite differences in comorbidity, stage and surgical outcome of patients with screen-detected tumours compared to nonscreen-detected tumours were not significantly different. Considering its limited oncological benefits as well as the rate of adverse events, surgery for nonmalignant polyps and T1 CRC should be considered carefully.
2014 年，荷兰启动了全国结直肠癌（CRC）筛查计划。对于 CRC 患者，很难评估手术的肿瘤学益处是否超过手术的发病率，尤其是在早期病变中。本研究比较了筛查发现和非筛查发现的患者的患者和肿瘤特征。此外，我们还介绍了治疗早期结直肠疾病患者时的治疗选择和临床困境。
2014 年 1 月至 2016 年 12 月，所有被转诊到荷兰莱顿大学医学中心外科的非恶性息肉或 CRC 患者均被纳入研究。比较了筛查发现和非筛查发现的结直肠肿瘤患者的基线特征、治疗类型和短期结局。
共纳入 426 例患者，其中 240 例（56.3%）是通过筛查发现的。非筛查发现的患者更常患有合并症（P = 0.03），原发肿瘤更常位于直肠（P = 0.001），并且转移性疾病的发生率更高（P < 0.001）。在 354 例接受手术治疗的患者中，两组患者的术后不良事件发生率无显著差异（P = 0.38）。在 46 例内镜切除标本中 T1 CRC 患者中，有 23 例接受了手术切除，其中只有 30.4%的患者在结肠切除时仍有浸润性疾病。
尽管筛查发现的肿瘤患者与非筛查发现的肿瘤患者在合并症、分期和手术结局方面存在差异，但差异无统计学意义。考虑到其有限的肿瘤学益处以及不良事件的发生率，对于非恶性息肉和 T1 CRC，应慎重考虑手术治疗。
