No Improvement in Long-Term Outcomes With Extended Colectomy for Sporadic Colorectal Cancer in Patients Younger Than Age 50
Extended colectomy in patients with sporadic colorectal cancer who were younger than age 50, in comparison with segmental resection, did not improve the risk of tumor recurrence or disease-free survival, according to the results of a retrospective study presented by Klos et al in the Journal of Surgical Oncology. This finding comparing extended vs segmental resection in younger patients further affirmed the use of segmental resection in this patient population.
Sporadic colorectal cancer is a challenging condition to diagnose and manage. In most cases, it is seen in patients over the age of 50 years. However, over the past 10 years, there has been an increase in the incidence of sporadic colorectal cancer in patients under the age of 50 years. Contributing factors to this rise in its incidence include improved screening programs, dietary changes, and a rising level of obesity in younger individuals. With this increase among younger individuals comes the question of what is the most appropriate approach to surgical treatment.
Contemporary surgical management centers on extensive colectomy or segmental resection. Current National Comprehensive Cancer Network guidelines on the management of colon cancer state that more extensive colectomy should be “considered” for patients of young age (< 50). However, few studies have delved into the long-term outcomes associated with extensive colectomy in patients under the age of 50 years. Thus, Klos and colleagues compared the overall rates of tumor recurrence and mortality in younger patients with sporadic colorectal cancer who underwent either extended colectomy or segmental resection.
Study Details
The investigators analyzed the medical records of 301 patients with sporadic colorectal cancer who underwent surgical resection with curative intent. Patients were categorized by the type of surgery to either the segmental resection group (including hemicolectomy, extended hemicolectomy, low anterior resection, and abdominoperineal resection) or the extended resection group (including subtotal abdominal colectomy with and without ileorectal anastomosis and total proctocolectomy with and without ileal pouch–anal anastomosis). Primary outcome measures were tumor recurrence, overall survival, and the incidence of metachronous lesions per group.
It should be noted that patients who underwent segmental resection were significantly older than those who underwent extended resection (43.2 vs 37.7 years; P = .004). In addition, the distribution of the tumor locations was significantly different between the two treatment groups (P = .001), but there was no significant difference regarding the stage of disease.
No Improvements in Outcome With Extended Resection
After 2-year follow-up, there was no statistically significant difference in the risk of tumor recurrence or mortality in patients who underwent segmental resection compared with those who underwent extended resection (recurrence hazard ratio [HR] = 1.33; P = .48; mortality HR = 1.36; P = .63). However, nine patients (3.3%) in the segmental resection group developed metachronous colorectal cancer after a median of 2 years.
The investigators also noted that those who presented between the ages of 40 and 50 had a lower risk of tumor recurrence than those who presented before the age of 40 (risk ratio [RR] = 0.595; confidence interval [CI] = 0.36–0.99). In addition, there was a lower risk of tumor recurrence associated with females (RR = 0.61; CI = 0.38–0.99). Disease stage was the only independent risk factor for mortality (RR = 3.96; CI = 1.64–9.58).
Clinical Implications
Although there was no difference in long-term outcomes between resection types, the investigators suggested that extended surgical resection may be considered as a preventative measure to reduce the risk of metachronous disease in those with a hereditary condition who have already developed a malignancy. It was also noted that future studies should focus on identifying subpopulations of patients who present with sporadic colorectal cancer below the age of 50 who may benefit from extended resection. These subpopulations would include patients who are highly suspected but unconfirmed carriers of a genetic variant predisposing for colorectal cancer.
The investigators remarked, “Based upon our data, we believe that segmental resection is appropriate oncologic treatment for those who present with sporadic colorectal cancer under the age of 50.”
Sekhar Dharmarajan, MD, of the Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, is the corresponding author of the article in the Journal of Surgical Oncology.The authors reported no potential conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
