To select patients for neoadjuvant therapy in colon cancer, there is a need to improve pre-therapeutic locoregional staging. There are now data showing that the TN stage can be adequately assessed by preoperative CT in dedicated centres. In Sweden the use of preoperative CT of the abdomen for staging of the primary tumour is increasing. The aim of this study was to determine to what extent the preoperatively reported radiological TN stage correlates with the histopathological TN stage in an entire population.
Data were collected on the preoperative cTN stage according to the radiologist and postoperative pTN stage according to the pathologist on all patients operated on for colon cancer in Sweden 2007-2010. The correlation between cTN stage and pTN stage was calculated using kappa statistics.
T stage was compared in 4373 patients with cT and pT stage. The correlation coefficient was 0.44, indicating fair agreement. The cN and pN correlation coefficient was 0.28, indicating a slight correlation. There was no difference in correlation related to age, gender, tumour location, body mass index or emergent vs elective surgery. A slight difference was seen between different geographical regions.
Preoperative CT in an unselected population does not result in an accurate cTN staging as previously reported from dedicated centres. To achieve adequate preoperative cTN staging nationally, the education of radiologists and optimization of the radiological method will be necessary.
Outcomes in rectal cancer have improved dramatically after the introduction of total mesorectal excision (TME). Recently, the TME concept has been transformed into that of complete mesocolic excision (CME) in an attempt to improve prognosis for patients with colon cancer.
Multidisciplinary team (MDT) workshops including the CME concept were held annually between 2004 and 2008 at the Karolinska University Hospital. The workshops focused on preoperative staging, surgery and histopathology and included lectures and live surgery sessions. To compare survival before and after the "Stockholm Colon Cancer Project" all patients diagnosed with a right sided colon cancer between January 1, 2001 and December 31, 2003 (Group 1) and from January 1, 2006 until December 31, 2008 (Group 2) in Stockholm were identified from the Swedish ColoRectal Cancer Registry (SCRCR).
The proportion of patients having a tumour resection and the proportion having emergency surgery was higher in Group 1. There were more early tumours and more R0 resections in Group 2. Overall survival in all diagnosed patients and disease free survival after tumour resection was improved in the second time period.
Surgical teaching programmes may have an impact on the management and outcome in colon cancer. The exact impact from the "Stockholm Colon Cancer Project" cannot be established, however it is likely that it contributed to the improved survival.
In recent decades, the focus has been on the treatment of rectal cancer with improved surgical techniques. This has resulted in improved results for patients with rectal cancer. Recently, the focus has shifted to colon cancer surgery with the introduction of preoperative staging, new surgical techniques, quality control and enhanced recovery programmes. The change in operative techniques has been most pronounced for patients with tumours on the right side of the colon, with more extensive resections and proximal ligations of the vessels. The aim of this study was to assess the number of analysed lymph nodes and the metastatic index (MI) in patients operated on for right-sided colon cancer in the Stockholm area between 1996 and 2009.
All patients operated on for cancer of the right colon between January 1996 and December 2009 were divided into three groups based on the year in which they were operated (period 1, 1996-1999; period 2, 2000-2004; and period 3, 2005-2009). The number of lymph nodes and lymph node status were analysed.
In total, 3536 patients were operated on for right-sided colon cancer during the study period. There was a significantly lower proportion of emergency operations in the third time period. The mean number of lymph nodes examined increased significantly during the overall study period (seven in period 1, 11 in period 2 and 18 in period 3; P
Although the median age of patients diagnosed with colon cancer is over 70 years, little is known about specific characteristics and management in the elderly. The aim of this study was to define the characteristics of colon cancer in elderly patients and compare the quality of preoperative assessment and surgery with that of younger patients undergoing surgery for colon cancer.
Data on 15,255 patients diagnosed with colon cancer between 2007 and 2010 were retrieved from the Swedish National Colon Cancer Register. Of these, 12,959 underwent surgical resection: 6141 were 75 years or older while 6818 were younger. The ?(2) test, Mann-Whitney U-test and univariable and multivariable logistic regression analyses were used for between-group comparison.
Older patients were more likely to be female (54% older/48% younger) and have right-sided cancer (60% older/49% younger). Among patients who underwent resection, the elderly were less often evaluated regarding tumour stage prior to surgery (59% older/65% younger) and they were less often evaluated at a multidisciplinary team conference (26% older/34% younger). Elderly patients more frequently underwent emergency surgery (22% older/19% younger) despite having an earlier cancer stage. When adjusted for stage, fewer elderly patients underwent a radical curative procedure (OR for noncurative resection 1.19; 95% CI 1.06-1.33).
Routine management of patients with colon cancer is age-dependent. Patients aged 75 years and older are less often completely staged and less often evaluated at a multidisciplinary team conference prior to surgery. Adjusted for stage, fewer elderly patients undergo curative resection.
Evaluating the external validity of clinical trials requires knowledge not only of the study population but also of a relevant reference population. The main aim of this study was to present data from a large, contemporary, population-based cohort of patients with colonic cancer.
Data on patients diagnosed between 2007 and 2011 were extracted from the Swedish Colon Cancer Registry. The data, registered prospectively in a national population of almost 10 million, included over 99 per cent of all diagnosed adenocarcinomas of the colon.
This analysis included 18,889 patients with 19,526 tumours (3·0 per cent had synchronous tumours). The sex distribution was fairly equal, and the median age was 74·1 (interquartile range 65-81) years. The overall and relative (cancer-specific) survival rates after 3 years were 62·7 and 71·4 per cent respectively. Some 88·0 per cent of the patients were operated on, and 83·8 per cent had tumours resected. Median blood loss during bowel resection was 200 (mean 311) ml, and the median operating time was 160 min; 5·6 per cent of the procedures were laparoscopic. Preoperative chemotherapy was administered to 2·1 per cent of patients; postoperative chemotherapy was planned in 90·1 per cent of fit patients aged less than 75 years with stage III disease. In patients operated on in an emergency setting (21·5 per cent), the preoperative evaluation was less extensive, the proportion of R0 resections was lower, and the outcomes were poorer, in both the short and long term.
These population-based data represent good-quality reference points.
AIMS: Reports from specialized centres suggest that 20-25% of patients with hepatic metastases from colorectal cancer have resectable disease, with 5-year survival rates of 30-40%, and that an additional 13-38% may become resectable after chemotherapy. The purpose of this study was to assess the potential for improvement in outcome for patients with hepatic metastases from colon cancer in an unselected population. PATIENTS AND METHODS: All patients diagnosed with colon cancer in the Stockholm/Gotland region between 1 January 1996 and 31 December 1999 were identified and followed until 31 December 2002. Treatment and outcome in patients with hepatic metastases was analyzed and CT-scans and MR images of the liver were reviewed to re-evaluate resectability. RESULTS: In 2280 patients with colon cancer, hepatic metastases were diagnosed in 537 patients. Only 21 of these patients underwent a hepatic resection. Retrospective evaluation of liver images indicated that 10% of the patients had potentially resectable hepatic disease. CONCLUSION: The rate of potentially resectable liver metastases from colon cancer in a population is lower than suggested from hospital-based series. With structured management programs including follow-up routines and multidisciplinary treatment protocols the proportion of patients amenable for liver resection may be increased. In this study preoperative chemotherapy might have increased the resectability rate to at the most 17%. To significantly improve prognosis for patients with hepatic metastases from colon cancer more effective treatment modalities are needed.
Preoperative staging of colon cancer according to Swedish national guidelines implies imaging evaluation of the primary tumour, liver and lungs. Failure to adhere to these guidelines results in negative scorings in the national registration system. In the present study we report the extent of compliance with these guidelines.
Since 2007 clinical data on all patients diagnosed with colon cancer in Sweden have been collected in a national database. This includes information on pretherapeutic diagnostic imaging performed, pretherapeutic TNM stage and data on treatment and follow-up. All patients diagnosed with colon cancer in Sweden between 2007 and 2010 were included.
Nine thousand and eight-three patients (i.e. 60.5% of all patients) had a complete pretherapeutic radiological evaluation; 65.2% had a CT or MRI of the primary tumour, whereas over 80% had examinations of the liver and lungs. There were no difference related to sex, but more patients under 75 years had a complete evaluation. There were large differences between different regions; one region performed a complete evaluation of 78.3% of all patients. The proportion of patients examined increased from 53.9 to 65.0% during the study period. Elective cases were more frequently evaluated before treatment than those with an emergency presentation.
Most patients in Sweden had a complete pretreatment imaging evaluation of the colon cancer with geographical and time-dependent variations. Knowledge of the importance of these variations and correlation of pre- and postoperative TNM stage is warranted, and such studies are ongoing.
The reported long waiting times for cancer patients have mostly been related to prognostic outcome and less to patient-related experience to outcome. We assessed waiting times for patients with cancer of the breast, prostate, colon or rectum in Sweden.
The median time from referral to start of treatment was assessed using data from clinical cancer registers for patients who received curative treatment during 2011, 2012 and 2013.
The median overall waiting time in different counties ranged from 7 to 28 days for breast cancer, from 117 to 280 days for prostate cancer, from 27 to 64 days for colon cancer and from 48 to 80 days for rectal cancer. For the entire nation, the median time from referral to start of treatment remained unchanged from 2011 to 2013 for each cancer diagnosis.
Large variations were found in waiting times between different counties in Sweden and between different types of cancer. The long waiting times identified in this study emphasize the need to improve national programmes for more rapid diagnosis and treatment.