Paszat Lawrence F, Sutradhar Rinku, Corn Elyse, Luo Jin, Baxter Nancy N, Tinmouth Jill, Rabeneck Linda
Institute for Healthcare Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
Cancer Programme, ICES, Toronto, Ontario, Canada.
J Med Screen. 2021 Sep;28(3):252-260. doi: 10.1177/0969141320957361. Epub 2020 Sep 20.
In 2008, Ontario initiated a population-based colorectal screening program using guaiac fecal occult blood testing. This work was undertaken to fill a major gap in knowledge by estimating serious post-operative complications and mortality following major large bowel resection of colorectal cancer detected by a population-based screening program.
We identified persons with a first positive fecal occult blood result between 2008 and 2016, at the age of 50-74 years, who underwent a colonoscopy within 6 months, and proceeded to major large bowel resection for colon cancer within 6 months or rectosigmoid/rectal cancer within 12 months, and identified an unscreened cohort of resected cases diagnosed during the same years at the age of 50-74 years. We identified serious postoperative complications and readmissions ≤30 days following resection, and postoperative mortality ≤30 days, and between 31 and 90 days among the screen-detected and the unscreened cohorts.
Serious post-operative complications or readmissions within 30 days were observed among 1476/4999 (29.5%) cases in the screen-detected cohort, and among 3060/8848 (34.6%) unscreened cases. Mortality within 30 days was 43/4999 (0.9%) among the screen-detected cohort, and 208/8848 (2.4%) among the unscreened cohort. Among 30 day survivors, mortality between 31 and 90 days was 28/4956 (0.6%) and 111/8640 (1.3%), respectively.
Serious post-operative complications, readmissions, and mortality may be more common following major large bowel resection for colorectal cancer between the ages of 50 and 74 among unscreened compared to screen-detected cases.
2008年，安大略省启动了一项基于人群的结直肠癌筛查项目，采用愈创木脂粪便潜血试验。本研究旨在通过估计基于人群的筛查项目检测出的结直肠癌患者在接受大肠大切除术后的严重术后并发症和死亡率，填补这一知识领域的重大空白。
我们确定了2008年至2016年间粪便潜血首次检测呈阳性、年龄在50 - 74岁之间、在6个月内接受结肠镜检查、并在6个月内接受结肠癌大肠大切除或在12个月内接受乙状结肠直肠/直肠癌切除的患者，并确定了同年诊断的50 - 74岁未筛查的切除病例队列。我们确定了筛查组和未筛查组患者术后≤30天的严重术后并发症和再入院情况，以及术后≤30天、31至90天的术后死亡率。
筛查组4999例中有1476例（29.5%）在术后30天内出现严重术后并发症或再入院，未筛查组8848例中有3060例（34.6%）出现此类情况。筛查组术后30天内死亡率为43/4999（0.9%），未筛查组为208/8848（2.4%）。在30天幸存者中，31至90天的死亡率分别为28/4956（0.6%）和111/8640（1.3%）。
与筛查出的病例相比，50至74岁未筛查的结直肠癌患者在接受大肠大切除术后，严重术后并发症、再入院和死亡率可能更为常见。
