Surgical Guidelines Often Ignored in Colorectal Cancer

Only one-third of patients with locally advanced disease may receive multivisceral resection

FRIDAY, Oct. 20 (HealthDay News) -- Most patients with locally advanced colorectal cancer do not received multivisceral resection as recommended by the National Cancer Institute and the American Society of Colon and Rectal Surgeons, according to a study published in the Oct. 18 issue of the Journal of the National Cancer Institute.

Calvin H.L. Law, M.D., of the University of Toronto in Canada, and colleagues analyzed data on 8,380 patients who received surgery for non-metastatic, locally advanced colorectal cancer between 1988 and 2002.

The researchers found that only 33.3 percent of the patients were managed with multivisceral resection. They also found that multivisceral resection was associated with improved overall survival for patients with colon cancer (hazard ratio, 0.89) and rectal cancer (HR, 0.81) with no associated increase in early mortality compared to those receiving standard resection. Younger age at diagnosis and female sex were factors associated with multivisceral resection in both colon and rectal cancer patients. Region, node negativity and left-sided tumors were independently associated with having had a multivisceral resection in colon cancer patients only.

"This study is, to our knowledge, the first to examine, at a population level, the rate of surgical management and outcomes for a cohort of patients who underwent surgery for locally advanced adherent colorectal cancer," the authors write. "Given that appropriate surgery is a critical step in the treatment of these patients, further study is warranted to elucidate factors related to the structures and processes of care that contribute to deficiencies in surgical care and to determine future interventions to improve the quality of care delivered to this population of patients."

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