Elnaggar Mahmoud, Pratheepan Ponnuthurai, Paramagurunathan Baskaran, Colemeadow Josie, Hussein Basim, Bashkirova Varvara, Pillai Kavya, Singh Lucy, Chawla Mehar
Colorectal Surgery, North Middlesex University Hospital NHS Trust, London, GBR.
General Surgery, North Middlesex University Hospital NHS Trust, London, GBR.
Cureus. 2023 Mar 29;15(3):e36840. doi: 10.7759/cureus.36840. eCollection 2023 Mar.
Aim Since the introduction of the target referral system, there has been controversy about its value and whether it affected the short- and long-term outcomes of colorectal cancer surgeries. With contradicting results, this study highlights differences in personal and tumour characteristics, management differences, and outcomes in each referral pathway, including target pathway referrals for suspected cancers, emergency presentations, routine referrals, and incidentally discovered cancers during screening. Methods A retrospective study of colorectal cancer (CRC) patients operated on between January 1, 2010, and December 31, 2014, with records dating to the end of the five-year follow-up, was extracted anonymously from the database of CRC outcomes at the North Middlesex University Hospital NHS Trust, London. The total number of patients operated on through the four pathways was 176, with full records and competent follow-ups. Patients were classified according to the mode of referral: two-week wait (2WW or target), routine, emergency, and incidental discovery referrals. Comparisons were made between these groups with regard to personal and tumour characteristics, management, and outcome. Results It has been demonstrated by this study that target referrals present mainly with stage I cancers as compared to emergency referrals that present with more stage II (IIa+ IIb+ IIc). The highest percentage of cancer locations within the large bowel was rectal, followed by sigmoid in both target and emergency groups; 8.8% of target patients needed neoadjuvant chemoradiotherapy in the form of FOLFOX (folinic acid, 5-fluorouracil, and oxaliplatin) chemotherapy protocol with the addition of radiotherapy in patients with advanced rectal cancers, compared to 13.3% of emergency patients. Conclusion The colorectal 2WW system was the main pathway supplying colorectal cancer operations; it mostly showed earlier cancers than the other referral groups; its cancers were mostly rectosigmoid with less need for adjuvant chemotherapy; fewer recurrences; and it also showed a lower five-year mortality rate than the emergency group.
目的 自引入目标转诊系统以来，关于其价值以及是否影响结直肠癌手术的短期和长期结果一直存在争议。由于结果相互矛盾，本研究突出了每种转诊途径在个人和肿瘤特征、管理差异以及结果方面的不同，包括疑似癌症的目标途径转诊、急诊就诊、常规转诊以及筛查期间偶然发现的癌症。方法 对2010年1月1日至2014年12月31日期间接受手术的结直肠癌（CRC）患者进行回顾性研究，记录追溯至五年随访结束，这些记录从伦敦北米德尔塞克斯大学医院国民保健服务信托基金的CRC结果数据库中匿名提取。通过这四种途径接受手术的患者总数为176例，有完整记录且随访充分。患者根据转诊方式分类：两周等待（2WW或目标）、常规、急诊和偶然发现转诊。对这些组在个人和肿瘤特征、管理及结果方面进行比较。结果 本研究表明，与表现为更多II期（IIa + IIb + IIc）的急诊转诊相比，目标转诊主要表现为I期癌症。大肠内癌症位置百分比最高的是直肠，其次是乙状结肠，在目标组和急诊组中均如此；8.8%的目标患者需要以FOLFOX（亚叶酸、5-氟尿嘧啶和奥沙利铂）化疗方案形式进行新辅助放化疗，并在晚期直肠癌患者中加用放疗，而急诊患者的这一比例为13.3%。结论 结直肠癌2WW系统是提供结直肠癌手术的主要途径；与其他转诊组相比，它大多显示癌症分期更早；其癌症大多位于直肠乙状结肠，辅助化疗需求较少；复发较少；并且其五年死亡率也低于急诊组。
