Disease-Free, Overall Survival Lower in Patients With CRC Treated With PE, CRS/HIPEC

Patients with early-onset colorectal cancer (EOCRC) were found to more often have stoma formation, pelvic exenteration (PE), and cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC), which led to poor disease-free survival (DFS) and overall survival (OS) in this cohort, according to a study published in ANZ Journal of Surgery.

Patients in whom who CRC is diagnosed before age 50 years are considered as having EOCRC, with incidence increasing worldwide. This diagnosis can often be delayed, however, as patients frequently believe that family history is the only reason to have a screening prior to age 50 years. Studies that evaluate the surgical management of EOCRC are few, even as CRS/HIPEC and PE are becoming more common in treating patients with stage IV CRC. This study aimed to assess the outcomes in patients with EOCRC after their resections.

Colorectal cancer | Image credit: ryanking999 - stock.adobe.com

The study, which evaluated patients who were treated in the Colorectal Surgical Unit at the Royal Prince Alfred Hospital in Sydney, Australia, took place from January 2013 to December 2021. Patients were included if they had surgical resection for CRC and had diagnosed colorectal adenocarcinoma before age 50 years. Electronic records were used to collect information on the primary operations in patients, along with their demographic and surgical outcome data. Complication severity was assessed using the Clavien-Dindo Classification system. DFS, OS, and absolute survival was also collected.

There were 111 patients with EOCRC who were included in this study, of which 57.66% were women, and the mean (SD) age was 38.20 (6.80) years. A total of 46.85% of patients had EOCRC diagnosed between ages 40 and 49 years, and 41.44%, between ages 30 and 39 years. There were 61.26% of patients who had colon cancer and 80% of all tumors in all of the patients were on the left side.

A total of 72.07% of patients did not receive CRS/HIPEC or PE, with low anterior resection performed in 19.82% of these patients. The remaining patients had either CRS/HIPEC or PE, with CRS/HIPEC performed in 15.32% and PE performed in 11.71%. A total of 50.45% of patients had a stoma.

Intensive Care Unit admission following the operation was found in 40.54% of patients, and the mean length of stay was 5.80 (11.60) days. A total of 30.63% of patients were administered total parenteral nutrition for a mean of 16.10 (23.20) days. Complications were found in 54.95% of patients, with grade 2 on the Clavien-Dindo classification being the most common at 47.54% followed by 19.67% in grade 3 and 16.39% in grades I and 4.

The median (IQR) follow-up time to assess survival was 21.00 (8.00-36.50) months, with 38.74% of patients having disease recurrence and the median DFS being 13.90 (7.20-29.30) months. The absolute survival rates were 93.69%, 87.39%, and 86.48% after 1, 3, and 5 years, respectively. Patients who had PE and CRS/HIPEC had an adverse DFS and OS compared with other patients who had colorectal resections in stage 4 CRC.

There were some limitations to this study. A single quaternary referral center was used for all of the data included, and 30 patients were excluded due to lack of data on their primary operation. Also, electronic medical records did not collect data on molecular mutations from a primary operation or adjuvant chemotherapy regiments, and selection bias could have existed due to the retrospective design. Lastly, this analysis covered a small population of patients with EOCRC compared with patients with late-onset CRC, and the researchers did not compare EOCRC with late-onset CRC in terms of outcomes and survival for this study.

The researchers concluded that, although postoperative complications were common, most of them were minor in patients with EOCRC, with DFS and OS being poorer in patients who had CRS/HIPEC or PE. Future research should focus on comparing patients with EOCRC with late-onset CRC and how these outcomes affect quality of life in patients with EOCRC.

Reference

Garrett C, Steffens D, Soloman M, Koh C. Surgical and survival outcomes of early-onset colorectal cancer patients: a single-centre descriptive Australian study. ANZ J Surg. Published online March 12, 2024. doi:10.1111/ans.18938