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A Population-Based Study of the Extent of Surgical Resection of Potentially Curable Colon Cancer

From the Departments of Surgical Oncology (AME, JAC) and Epidemiology & Statistics (HS), Princess Margaret Hospital, Toronto, Ontario, Canada; Division of Preventive Oncology (MC), Surveillance Unit (EH), Ontario Cancer Registry (DD), Cancer Care Ontario, Toronto, Ontario, Canada; and the Familial GI Cancer Registry (MA) and Department of Surgery (SG), University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada.

Correspondence: Address correspondence and reprint requests to: Alexandra Easson, MD, Room 3-130, Department of Surgical Oncology, Princess Margaret Hospital, 610 University Ave., Toronto, Ontario M5G 2M9, Canada; Fax: 416-946-6590; E-mail: easson.alexandra{at}uhn.on.ca

Background: We attempted to determine factors contributing to the extent of initial curative resection for colon cancer in a population-based cohort. Total abdominal colectomy with ileorectal anastomosis (TAC-IR) may be considered for young patients or those with a colorectal cancer family history to prevent metachronous lesions and facilitate surveillance.

Methods: All Ontario patients newly diagnosed with colon cancer over 12 months beginning in July 1997 were staged at the time of surgery. The extent of resection was compared with variables, including familial risk obtained from the Ontario Familial Colon Cancer Registry.

Results: Complete staging was possible for 86% of patients. A total of 1223 patients had a potentially curative resection: 17%, 46%, and 36% were stage I, II, and III, respectively. Patients were more likely to receive a TAC-IR if they were 50 years old (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.8–6.6), if they had a synchronous lesion (OR, 28.37; 95% CI, 12.2–61.2), or if they were at a teaching hospital (OR, 2.8; 95% CI, 1.6–4.7), but not if they had a family history (OR, .7; 95% CI, .3– 1.5).

Conclusions: Young age, teaching hospital, and multiple cancers but not family history were important factors for performing a TAC-IR.

Key Words: Colorectal neoplasms • Surgery • Family history • Epidemiology • Neoplasm staging • Familial colorectal cancer

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