FALLING EMERGENCY OPERATION RATES AND REDUCED MORTALITY AFTER COLON CANCER SURGERY IN ENGLAND: A COHORT STUDY
Author(s)
Byrne, BE
Vincent, CA
Stebbing, J
Darzi, A
Faiz, OD
Type
Conference Paper
Abstract
Introduction Recent years have seen many changes within colorectal surgery. Laparoscopic techniques, fast track management, and bowel cancer screening have become widespread. This study examined changes in surgical treatment and outcomes for colon cancer over time against background registration rates, with subgroup analysis by urgency and age.
Method Annual data on colon cancer registrations and population size was obtained. Administrative data were used to identify adults undergoing colonic resection for cancer in England between April 1998 and March 2012. Cancer registrations, treatment and mortality rates were age-standardised. The proportion of registrations undergoing surgery was examined, and subgroups were analysed by urgency of admission and age group. Temporal trends were assessed using the Joinpoint Regression Program (National Cancer Institute, USA).
Results The standardised rate of colon cancer registration rose from 27.1 to 29.1 per 100 000 population. The proportion of registrations undergoing surgery fell, from approximately 67% to 57% (Annual Percentage Change = −1.44, p < 0.05), due to a significant fall in non-elective operating; the elective treatment rate did not change. Postoperative 90-day mortality rates fell across all age groups for elective and non-elective surgery, from approximately 6.5% to 3% and 19% to 13%, respectively.
Conclusion Colon cancer registrations increased over time. The surgical treatment rate per colon cancer fell, due to falling rates of non-elective surgery. Possible explanations include improved early detection of colon cancer, changes in case selection, and improvements in non-surgical treatments. Postoperative mortality fell significantly after elective and non-elective surgery for all age groups. Considered together, these findings suggest a global improvement in the quality of surgical care for colon cancer. Future studies should include non-surgical treatments with information on stage of cancer at presentation.
Method Annual data on colon cancer registrations and population size was obtained. Administrative data were used to identify adults undergoing colonic resection for cancer in England between April 1998 and March 2012. Cancer registrations, treatment and mortality rates were age-standardised. The proportion of registrations undergoing surgery was examined, and subgroups were analysed by urgency of admission and age group. Temporal trends were assessed using the Joinpoint Regression Program (National Cancer Institute, USA).
Results The standardised rate of colon cancer registration rose from 27.1 to 29.1 per 100 000 population. The proportion of registrations undergoing surgery fell, from approximately 67% to 57% (Annual Percentage Change = −1.44, p < 0.05), due to a significant fall in non-elective operating; the elective treatment rate did not change. Postoperative 90-day mortality rates fell across all age groups for elective and non-elective surgery, from approximately 6.5% to 3% and 19% to 13%, respectively.
Conclusion Colon cancer registrations increased over time. The surgical treatment rate per colon cancer fell, due to falling rates of non-elective surgery. Possible explanations include improved early detection of colon cancer, changes in case selection, and improvements in non-surgical treatments. Postoperative mortality fell significantly after elective and non-elective surgery for all age groups. Considered together, these findings suggest a global improvement in the quality of surgical care for colon cancer. Future studies should include non-surgical treatments with information on stage of cancer at presentation.
Date Issued
2015-06-22
Date Acceptance
2015-06-22
Citation
GUT, 2015, 64 (Suppl 1), pp.A339-A340
ISSN
0017-5749
Publisher
BMJ PUBLISHING GROUP
Start Page
A339
End Page
A340
Journal / Book Title
GUT
Volume
64
Issue
Suppl 1
Copyright Statement
© 2015 The Author(s). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. This article has been accepted for publication in Gut following peer review. The definitive copyedited, typeset version Byrne B, Vincent C, Stebbing J, et al
PWE-291 Falling emergency operation rates and reduced mortality after colon cancer surgery in england: a cohort study
Gut 2015;64:A339-A340, is available online at: https://dx.doi.org/10.1136/gutjnl-2015-309861.737
PWE-291 Falling emergency operation rates and reduced mortality after colon cancer surgery in england: a cohort study
Gut 2015;64:A339-A340, is available online at: https://dx.doi.org/10.1136/gutjnl-2015-309861.737
Source
2nd Digestive-Disorders-Federation Conference
Subjects
Science & Technology
Life Sciences & Biomedicine
Gastroenterology & Hepatology
Publication Status
Published
Start Date
2015-06-22
Finish Date
2015-06-22
Coverage Spatial
London, ENGLAND
Date Publish Online
2015-06-22