Survival after non-resection of colorectal cancer: the argument for including non-operatives in consultant outcome reporting in the UK

Although the mainstay of colorectal cancer treatment remains operative, a significant proportion of patients end up without surgery. This is because they are either deemed to have no oncological benefit from the resection (too much disease) or to be unfit for major surgery (too frail). The aim of th...

Full description

Saved in:
Bibliographic Details
Published in:Annals of the Royal College of Surgeons of England 2019-02, Vol.101 (2), p.126-132
Main Authors: Abdel-Halim, M, Wu, H, Poustie, M, Beveridge, A, Scott, N, Mitchell, P J
Format: Article
Language:English
Subjects:
Age
Aged
Chemotherapy
Clinical Decision-Making
Colorectal cancer
Colorectal Neoplasms - complications
Colorectal Neoplasms - mortality
Colorectal Neoplasms - pathology
Colorectal Neoplasms - therapy
Comorbidity
Female
Follow-Up Studies
Frailty
Frailty - complications
Frailty - mortality
Geriatrics
Humans
Male
Metastasis
Mortality
Neoplasm Staging
Older people
Palliative Care
Patient Selection
Patients
Perioperative Care
Physical fitness
Retrospective Studies
Surgeons
Surgery
Survival Analysis
Systematic review
Treatment Outcome
United Kingdom - epidemiology
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Although the mainstay of colorectal cancer treatment remains operative, a significant proportion of patients end up without surgery. This is because they are either deemed to have no oncological benefit from the resection (too much disease) or to be unfit for major surgery (too frail). The aim of this study was to assess the proportion and survival of these two groups among the totality of practice in a tertiary unit and to discuss the implications on the conceptual understanding of outcome measures. Data was collected over two study periods with the total duration of four years. Patient demographics, comorbidities, cancer staging and management pathways were all recorded. The primary endpoint was all-cause mortality. The total of 909 patients were examined. In the 29% who did not undergo resectional surgery, 6.5% had too little disease, 13.8% had too much disease, while 8.7% were deemed too frail. The highest two-year mortality was observed in the too much (83.2%) and too frail (75.9%) groups, whereas in patients with too little cancer the rate was 5.1%, and in those undergoing a resection it was 19.2% (P 
ISSN:0035-8843
1478-7083
DOI:10.1308/rcsann.2018.0180