Division of General Surgery, Department of Medical and Surgical Sciences, Hospital of Cattinara, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy.
Breast Unit Azienda Sanitaria Universitaria Integrata di Trieste-ASUITS¸ Division of General Surgery, Department of Medical and Surgical Sciences, Hospital of Cattinara, University of Trieste, Trieste, Italy.
Updates Surg. 2020 Mar;72(1):89-96. doi: 10.1007/s13304-020-00703-y. Epub 2020 Jan 8.
Screening programs (SC) have been proven to reduce both incidence and mortality of CRC. We retrospectively analyzed patients who underwent surgical treatment for CRC between 01/2011 and 01/2017. The current screening program in our region collects patients aged from 50 to 69. For this reason, out of a total of 600 patients, we compared 125 patients with CRC founded during the SC to 162 patients who presented with symptoms and were diagnosed between 50-69 years old (NO-SC). 45% patients in the SC group were diagnosed as AJCC stage I vs 27% patients in the NO-SC group; 14% vs 20% were stage II, 14% vs 26% were stage III, and 3% vs 14% were stage IV (p 0.002). We found a significant difference in surgical approach: 89% SC vs 56% NO-SC patients had laparoscopic surgery (p 0.002). In the NO-SC group, 16% patients underwent resection in an emergency setting. Only 5% patients in the SC group had postoperative complications vs 14% patients in the NO-SC group (p 0.03). We had a 2-year OS of 86%, being 95% in the SC group and 80% in the NO-SC group (p 0.002). Likewise, the whole 2-year DFS was 77%, whereas it was 90% in the SC group and 66% in the NO-SC group (p 0.002). Screening significantly improves early diagnosis and accelerated surgical treatment. We obtained earlier stages at diagnosis, a less invasive surgical approach, and lower rates of complications and emergency surgery, all this leading to an improvement in both OS and DFS.
筛查项目（Screening programs，SC）已被证实可降低 CRC 的发病率和死亡率。我们回顾性分析了 2011 年 1 月至 2017 年 1 月间接受 CRC 手术治疗的患者。本地区现行筛查项目针对 50-69 岁人群。因此，在总共 600 例患者中，我们将在 SC 中发现的 125 例 CRC 患者与因症状就诊并在 50-69 岁时确诊的 162 例患者（非 SC 组）进行了比较。SC 组中 45%的患者被诊断为 AJCC Ⅰ期，而非 SC 组中这一比例为 27%；Ⅱ期分别为 14%和 20%，Ⅲ期分别为 14%和 26%，Ⅳ期分别为 3%和 14%（p<0.002）。我们发现手术方式存在显著差异：89%的 SC 组患者和 56%的非 SC 组患者接受了腹腔镜手术（p<0.002）。在非 SC 组中，16%的患者在急诊时接受了切除手术。只有 5%的 SC 组患者出现术后并发症，而非 SC 组中这一比例为 14%（p<0.03）。我们的 2 年 OS 率为 86%，SC 组为 95%，非 SC 组为 80%（p<0.002）。同样，2 年 DFS 为 77%，SC 组为 90%，非 SC 组为 66%（p<0.002）。筛查显著改善了早期诊断并加速了手术治疗。我们在诊断时获得了更早的分期，采用了创伤更小的手术方式，且并发症和急诊手术的发生率更低，这一切都提高了 OS 和 DFS。
