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The impact of Screening Colonoscopy on Outcomes in Colon Cancer Surgery
*Ramzi Amri, *Liliana G Bordeianou, *Patricia Sylla, David L Berger Harvard Medical School/Massachusetts General Hospital, Boston, MA
Objective: Screening colonoscopy decreased overall rates of colorectal cancer in the United States. The NCI SEER database reported an annual percentage decrease in the incidence of colon cancer of 4.0% in 2002-2005 and 2.4% in 2005-2009. In addition to removing benign lesions and preventing progression, screening colonoscopy theoretically identifies asymptomatic patients with early stage disease, potentially leading to higher survival rates. This study aims to assess this effect in surgically treated colon cancer patients. Design: Retrospective review of prospectively maintained database. Setting: Tertiary care center. Patients: Patients operated for colonic adenocarcinoma (2006 -2011) at Massachusetts General Hospital, diagnosed through screening colonoscopy or after symptomatic presentation. Main Outcome Measures: Post-operative staging, survival and disease-free interval. Results: 597 patients were included. 460 patients were diagnosed after symptomatic presentation, 137 patients were diagnosed through screening. Symptomatic patients had a significantly higher risk of having nodal disease (44.8% vs. 27%; Relative Risk 1.66; 95%CI 1.24-2.22; p<0.001) and metastatic disease (18.3% vs. 7.3 %; RR 2.5; 95%CI 1.34-4.69; p=0.002) postoperatively. In follow-up (mean duration 757 vs. 818 days; p= .32) symptomatic patients had significantly higher death rates (20.7% vs. 5.8%; RR 3.5; 95% CI 1.76-7.09; p<0.001) and nonsignificantly lower recurrence rates (11.1% vs. 7.3%; RR 1.52 95%CI 0.8-2.91; p=0.199). Kaplan-Meier with Logrank test further demonstrates significant beneficial effect of screening on disease-free intervals (p<0.001) and survival (p<0.001). Conclusion: Patients with colon cancer identified on screening colonoscopy have significantly lower stage disease on presentation and significantly better outcomes than those with tumors identified because of symptoms.
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