Colon Cancer

2018 ◽  
Author(s):  
Richard S Hoehn ◽  
Felipe Quezada-Diaz ◽  
Jesse J Smith
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Surgical Resection ◽  
Distant Metastases ◽  
Disease Recurrence ◽  
The United States ◽  
Oncologic Outcomes ◽  
Perioperative Outcomes ◽  
Increased Risk ◽  
Localized Disease

Colon cancer is a leading cause of cancer-related death in the United States and worldwide. Routine screening has led to early diagnosis and improved survival for many patients but is still greatly underused. Complete surgical resection provides the best opportunity for cure of localized disease and requires removal of a defined segment of colon along with its lymphovascular pedicle, including a minimum of 12 lymph nodes. Minimally invasive approaches have been shown to provide better perioperative outcomes and patient recovery, with oncologic outcomes equivalent to those of traditional open surgery. Patients with lymph node metastases are at an increased risk of distant metastases and disease recurrence. Survival for these patients has improved in the recent years with the advent of oxaliplatin-based adjuvant chemotherapy. In addition, surgical resection is increasingly being used to control and sometimes cure distant metastases. In this chapter, we review the current strategies for diagnosing and managing colon cancer.   This review contains 1 video, 5 figures, 4 tables and 48 references Key Words: adjuvant chemotherapy, anastomosis, colectomy, colon cancer, neoadjuvant chemotherapy, surgery, survival, laparoscopic, robotic

Colon Cancer

2018 ◽  
Author(s):  
Richard S Hoehn ◽  
Felipe Quezada-Diaz ◽  
Jesse J Smith
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Surgical Resection ◽  
Distant Metastases ◽  
Disease Recurrence ◽  
The United States ◽  
Oncologic Outcomes ◽  
Perioperative Outcomes ◽  
Increased Risk ◽  
Localized Disease

Colon cancer is a leading cause of cancer-related death in the United States and worldwide. Routine screening has led to early diagnosis and improved survival for many patients but is still greatly underused. Complete surgical resection provides the best opportunity for cure of localized disease and requires removal of a defined segment of colon along with its lymphovascular pedicle, including a minimum of 12 lymph nodes. Minimally invasive approaches have been shown to provide better perioperative outcomes and patient recovery, with oncologic outcomes equivalent to those of traditional open surgery. Patients with lymph node metastases are at an increased risk of distant metastases and disease recurrence. Survival for these patients has improved in the recent years with the advent of oxaliplatin-based adjuvant chemotherapy. In addition, surgical resection is increasingly being used to control and sometimes cure distant metastases. In this chapter, we review the current strategies for diagnosing and managing colon cancer.   This review contains 1 video, 5 figures, 4 tables and 48 references Key Words: adjuvant chemotherapy, anastomosis, colectomy, colon cancer, neoadjuvant chemotherapy, surgery, survival, laparoscopic, robotic

Socioeconomic and clinical factors associated with delayed initiation of adjuvant chemotherapy for stage III colon cancer.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 173-173 ◽  
Author(s):  
Alex Bernard Haynes ◽  
Y. Sabrina Chiang ◽  
Genevieve Marie Boland ◽  
Yan Xing ◽  
Nader N. Massarweh ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Surgical Resection ◽  
Stage Iii ◽  
Unplanned Readmission ◽  
Coordinated Care ◽  
Cancer Data ◽  
Stage Iii Colon Cancer ◽  
Increased Risk

173 Background: We have previously described an association between a greater than 8-week interval to initiation of adjuvant chemotherapy after resection of stage III adenocarcinoma of the colon and an approximately 20% increased risk of mortality. We sought to understand the factors that lead to delay in chemotherapy initiation. Methods: Patients who received adjuvant chemotherapy after resection of stage III colon cancer between 2003 and 2007 were identified from the National Cancer Data Base. Delayed chemotherapy was defined as the first date of chemotherapy administration being eight weeks or more after surgical resection. Comorbidity was categorized using the Charlson/Deyo index. Prolonged length of stay and unplanned readmission were used as surrogates for surgical complications. Multivariate logistic regression was performed to examine the associations between various clinical and socioeconomic variables and delay in the receipt of adjuvant chemotherapy. Results: 33,011 stage III colon cancer patients who received chemotherapy after surgery were identified. 8,036 (24.3%) initiated chemotherapy more than eight weeks after surgical resection. Unplanned readmission (OR 1.76, 95% CI 1.58-1.95), prolonged postoperative stay (OR 1.56, 95% CI 1.48-1.65), and comorbidity (OR 1.18, 95% CI 1.12-1.25) were all independent predictors of delay. Nonclinical factors, including African-American race (OR 1.34, 95% CI 1.24-1.45), lack of insurance (OR 1.63, 95% CI 1.43-1.87), and residence more than 100 miles from treating center (OR 1.23, 95% CI 1.01-1.51) were also independently associated with delayed chemotherapy. Conclusions: Delay in the initiation of adjuvant therapy for colon cancer beyond 8 weeks has previously been found to be an independent predictor of increased mortality. While some delays may result from patient frailty or postoperative complications, these data suggest that nonclinical factors may also contribute to delays. Increased focus on overcoming barriers to coordinated care should be prioritized to ensure that those patients who may benefit from adjuvant therapy receive it in a timely fashion to optimize survival advantages.

scholarly journals Oncologic Outcomes of Oral Adjuvant Chemotherapy Regimens in Stage III Colon Cancer: Tegafur–Uracil Plus Leucovorin Versus Capecitabine

2017 ◽  
Vol 16 (3) ◽  
pp. e141-e145 ◽  
Author(s):  
Jo Tashiro ◽  
Shigeki Yamaguchi ◽  
Toshimasa Ishii ◽  
Hiroka Kondo ◽  
Kiyoka Hara ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Stage Iii ◽  
Oncologic Outcomes ◽  
Stage Iii Colon Cancer

Allogeneic Leukocyte-Reduced Red Blood Cell Transfusion Is Associated with Postoperative Infectious Complications and Cancer Recurrence after Colon Cancer Resection

2019 ◽  
Vol 37 (2) ◽  
pp. 163-170 ◽  
Author(s):  
Andrew-Paul Deeb ◽  
Christopher T. Aquina ◽  
John R.T. Monson ◽  
Neil Blumberg ◽  
Adan Z. Becerra ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Cancer Recurrence ◽  
Infectious Complications ◽  
Oncologic Outcomes ◽  
Red Blood Cell Transfusion ◽  
Elective Resection ◽  
Increased Risk ◽  
The Impact

Background/Aims: Transfusion rates in colon cancer surgery are traditionally very high. Allogeneic red blood cell (RBC) transfusions are reported to induce immunomodulation that contributes to infectious morbidity and adverse oncologic outcomes. In an effort to attenuate these effects, the study institution implemented a universal leukocyte reduction protocol. The purpose of this study was to examine the impact of leukocyte-reduced (LR) transfusions on postoperative infectious complications, recurrence-free survival, and overall survival (OS). Methods: In a retrospective study, patients with stage I–III adenocarcinoma of the colon from 2003 to 2010 who underwent elective resection were studied. The primary outcome measures were postoperative infectious complications and recurrence-free and OS in patients that received a transfusion. Bivariate and multivariable regression analyses were performed for each endpoint. Results: Of 294 patients, 66 (22%) received a LR RBC transfusion. After adjustment, transfusion of LR RBCs was found to be independently associated with increased infectious complications (OR 3.10, 95% CI 1.24–7.73), increased odds of cancer recurrence (hazard ratio [HR] 3.74, 95% CI 1.94–7.21), and reduced OS when ≥3 units were administered (HR 2.24, 95% CI 1.12–4.48). Conclusion: Transfusion of LR RBCs is associated with an increased risk of infectious complications and worsened survival after elective surgery for colon cancer, irrespective of leukocyte reduction.

scholarly journals Race and Insurance Differences in the Receipt of Adjuvant Chemotherapy Among Patients With Stage III Colon Cancer

2015 ◽  
Vol 33 (23) ◽  
pp. 2530-2536 ◽  
Author(s):  
Caitlin C. Murphy ◽  
Linda C. Harlan ◽  
Joan L. Warren ◽  
Ann M. Geiger
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Private Insurance ◽  
The United States ◽  
Stage Iii ◽  
Stage Iii Colon Cancer ◽  
Time Period ◽  
Black Patients ◽  
Incidence And Mortality ◽  
White Patients

Purpose Although the incidence and mortality of colon cancer in the United States has declined over the past two decades, blacks have worse outcomes than whites. Variations in treatment may contribute to mortality differentials. Methods Patients diagnosed with stage III colon cancer were randomly sampled from the SEER program from the years 1990, 1991, 1995, 2000, 2005, and 2010. Patients were categorized as non-Hispanic white (n = 835) or black (n = 384). Treatment data were obtained from a review of the medical records, and these data were verified through contact with the original treating physicians. Log-binomial regression models were used to estimate the association between race and receipt of adjuvant chemotherapy. Effect modification by insurance was assessed with use of single referent models. Results Receipt of adjuvant chemotherapy among both white and black patients increased from the period encompassing the years 1990 and 1991 (white, 58%; black, 45%) to the year 2005 (white, 72%; black, 71%) and then decreased in the year 2010 (white, 66%; black, 57%). There were marked racial disparities in the time period of 1990 to 1991 and again in 2010, with black patients less likely to receive adjuvant chemotherapy as compared with white patients (risk ratio [RR], .82; 95% CI, .72 to .93). For black patients, receipt of adjuvant chemotherapy did not differ across insurance categories (RR for private insurance, .80; 95% CI, .69 to .93; RR for Medicare, .84; 95% CI, .69 to 1.02; and RR for Medicaid, .84; 95% CI, .69 to 1.02), although a larger proportion had Medicaid in all years of the study as compared with white patients. Conclusion The chemotherapy differential narrowed after the time period of 1990 to 1991, but our findings suggest that the disparity reemerged in 2010. Recent decreases in chemotherapy use may be due, in part, to the economic downturn and an increase in Medicaid coverage.

Effect of postoperative complications on adjuvant chemotherapy use in stage III colon cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 3608-3608
Author(s):  
Ryan P Merkow ◽  
David J Bentrem ◽  
Mary Frances Mulcahy ◽  
Clifford Y. Ko ◽  
Karl Y. Bilimoria
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Postoperative Complications ◽  
Adjuvant Therapy ◽  
Anastomotic Leak ◽  
The United States ◽  
Stage Iii ◽  
Treatment Gap ◽  
Stage Iii Colon Cancer ◽  
National Quality

3608 Background: The National Quality Forum has endorsed the use of adjuvant chemotherapy in stage III colon cancer, yet a substantial treatment gap exists in the United States. Our objective was to evaluate the contribution of postoperative complications on the use of adjuvant therapy after colectomy for cancer. Methods: Patients from the National Surgical Quality Improvement Program and the National Cancer Data Base who underwent colon resection for cancer were linked (2006-2008). The association of complications on adjuvant chemotherapy use was assessed using multivariable regression models. Results: From 140 hospitals, 2368 patients underwent resection for stage III colon adenocarcinoma. Overall, 36.8% (871/2,368) patients were not treated with adjuvant therapy, of which 47.8% (416/871) had documented severe comorbidities or advanced age (≥80) as the reason for no adjuvant therapy receipt. Of the remaining 455 patients, 21.3% (97/455) had ≥1 serious complication that could account for adjuvant therapy omission. The remaining 41.1% (358/871) patients did not have a documented reason for not recieving adjuvant therapy. Complications associated with adjuvant therapy omission were abscess/anastomotic leak (OR 1.91, 95% CI 1.02-3.59), renal failure (OR 7.16, 95% CI 1.92-26.79), prolonged ventilation (OR 7.92, 95% CI 2.97-21.13), re-intubation (OR 5.69, 95% CI 2.13-15.18), and pneumonia (OR 4.05, 95% CI 2.07-7.90). Abscess/anastomotic leak was associated with a 28-day delay in time to adjuvant chemotherapy (73 vs. 45 days, p<0.05). Superficial surgical site infection did not decrease adjuvant therapy receipt but delayed the time to its use (57 vs. 44 days, p<0.05). The occurrence of postoperative sepsis was associated with a 15-day delay to adjuvant chemotherapy (60 vs. 45 days, p<0.05). Conclusions: Serious postoperative complications explained nearly one quarter of the adjuvant chemotherapy treatment gap among stage III colon cancer patients. Postoperative complications affect treatment utilization and should be considered when calculating adherence with the Stage III adjuvant therapy for colon cancer measure. Judging provider performance using quality metrics is challenging without clinical data.

Association of diabetes mellitus with increased mortality in patients receiving curative surgery for colon cancer.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 399-399
Author(s):  
Kuo-Hsing Chen ◽  
Yu Yun Shao ◽  
Yi-Chun Yeh ◽  
Wen-Yi Shau ◽  
Raymond Nienchen Kuo ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Colon Cancer ◽  
Multivariate Analysis ◽  
Adjuvant Chemotherapy ◽  
Population Based ◽  
Curative Surgery ◽  
Cancer Specific Survival ◽  
Initial Stage ◽  
Increased Risk ◽  
Early Colon Cancer

399 Background: Diabetes mellitus (DM) is associated with increased risk of colon cancer and has potential impact on its prognosis. This study aimed to investigate the association between DM and the prognosis of patients with early colon cancer who underwent curative surgery. Methods: We established the patient cohort of the study by searching the database of the population-based Taiwan National Cancer Registry. All patients who had newly diagnosed stage I or II colon cancer from 2004 to 2007 and underwent surgical resection with uninvolved surgical margins were enrolled. Information of DM, anti-DM medication, and other comorbidities was retrieved from the database of National Health Insurance, Taiwan. Colon cancer-specific survival (CSS) and overall survival (OS) were compared between patients with and without DM. The Cox proportional hazard model was used to estimate the adjusted hazard ratio (HR) of clinicopathologic variables in multivariate analysis. Results: A total of 5,525 patients were identified; 1,009 of them (18.9%) had DM and 4,325 of them (81.1%) had no DM. Patients with DM had an older median age at diagnosis (69.9 y vs. 66.8 y, p < 0.001), similar initial stage and grade, fewer adjuvant chemotherapy (26.5% vs. 31.2%, p = 0.003). Patients with DM had significantly poorer CSS and OS than patients without DM (Table). In multivariate analysis adjusting for age, gender, stage, adjuvant chemotherapy and comorbidities, DM remained an independent prognostic factor for poorer OS (adjusted HR: 1.45, p < 0.001). Among patients with DM, patients who used insulin had significantly poorer CSS and OS than patients who did not (5-year CSS: 79.5% vs. 85.5%, p = 0.047; 5-year OS: 50.9% vs. 70.4%, p < 0.001). Conclusions: In patients receiving curative surgery for early colon cancer, patients with DM had poorer OS than patients without DM. [Table: see text]

Utilization of surgery and its impact on survival in elderly patients with localized colon cancer in the United States.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15179-e15179
Author(s):  
Lubina Arjyal ◽  
Amir Bista ◽  
Michael Olayiwola Ojelabi
Keyword(s):  
United States ◽  
Colon Cancer ◽  
African Americans ◽  
Elderly Patients ◽  
Surgical Resection ◽  
The United States ◽  
Stage Iii ◽  
Lower Grade ◽  
Metastatic Colon Cancer ◽  
Impact On Survival

e15179 Background: For patients with localized colon cancer, surgical resection is the only curative treatment modality. Old age may be an independent factor associated with decreased receipt of surgery. We conducted this study to evaluate the utilization of surgery and its impact on survival in older patients with colon cancer in the United States. Methods: Surveillance, Epidemiology and End Results Database (SEER-18) was utilized to identify elderly patients (≥65 years) diagnosed from 2004-2013 with non-metastatic colon cancer (stage≤ III). Study population was divided into various cohorts based on race (Caucasian, African Americans, others), sex and age (< 80 years and ≥80 years), histology grade, tumor side, and stage. Multivariate logistic regression model was utilized to assess factors associated with receipt of surgery. Kaplan-Meier estimators with the log rank test was used to compare median overall survival (Md OS) between the surgery arm and non-surgery arm. Statistical significance was defined for p < 0.05. Results: Database identified 89,467 patients (54.7% female, 82.7% Caucasian; Median age 77 years). 94.6% (n = 84,656) of patients received surgery. On multivariate-analysis, left sided disease, lower grade tumor, lower stage, female gender, residents of lower median household income county, African Americans and age ≥80 years were less likely to receive surgery. The Md OS in the surgery arm was 87 months vs 69 months for non-surgery arm, p < 0.001. This benefit was seen in all the three stages (stage I: Md OS 104 vs 75 months; stage II: Md OS 88 vs 50 months; stage III: Md OS 74 vs 37 months, p < 0.001 for all comparisons). Additional analysis for octogenarians (age≥ 80 years) showed Md OS of 68 months in the surgery arm vs 48 months in the non-surgery arm, p < 0.001). Conclusions: Our study showed significant utilization of surgery (94.6%) in elderly patients with localized colon cancer. There is a clear survival benefit to surgery even in patients with age≥ 80 years. Surgical resection with curative intent should be strongly considered in patients with good performance status irrespective of age.

scholarly journals Mucosal melanoma of the oral cavity

2021 ◽  
Author(s):  
Kara Marie Ruicci ◽  
Meaghan Wunder
Keyword(s):  
Oral Cavity ◽  
Surgical Resection ◽  
Surgical Techniques ◽  
Disease Free Survival ◽  
Neck Region ◽  
Distant Metastases ◽  
Disease Recurrence ◽  
Mucosal Melanoma ◽  
Adjuvant Radiation ◽  
Pigmented Lesion

Primary mucosal melanomas of the head and neck region are uncommon but aggressive malignancies. These lesions arise from melanocytes located in mucosal membranes, predominantly in the nasal cavity, paranasal sinuses, and oral cavity. Mucosal melanomas account for less than 4% of all melanoma cases and are often missed, due to their occult initial presentations. This is in contrast to cutaneous melanomas, which constitute approximately 85% of melanoma cases and present on surfaces exposed to ultraviolet (UV) radiation. The mainstay of treatment for mucosal melanoma is surgical resection with adjuvant radiotherapy for patients with high-risk features. Despite advancements in surgical techniques, radiotherapy, and even systemic therapies, patients with mucosal melanoma face unfavourable prognoses (5-year disease-free survival <25%) with high rates of locoregional recurrence and/or distant metastases. The present case addresses a 47 year-old man who presents to Otolaryngology with an apparent mucosal melanoma involving the upper lip. This patient was informed of a pigmented lesion on the mucosal surface of the upper left lip three years prior by his dentist. Although largely asymptomatic, the lesion has increased in size. The patient undergoes surgical resection with clear margins and reconstruction. He continues to follow-up to monitor for disease recurrence, having denied adjuvant radiation. This case illustrates the diagnosis and approach to mucosal melanomas and highlights some of the key distinctions between mucosal and cutaneous melanomas.

scholarly journals Preoperative Sarcopenia is Associated with Poorer Compliance Rate of Adjuvant Chemotherapy and Worse Disease-free Survival of Patients with Stage Ⅲ Colon Cancer

2021 ◽  
Author(s):  
Liang Yu ◽  
Guangliang Chen ◽  
Zongbin Xu ◽  
Pan Chi ◽  
Zhifen Chen
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Perioperative Complications ◽  
Compliance Rate ◽  
Disease Free Survival ◽  
Perioperative Outcomes ◽  
Significant Prognostic Factor ◽  
Important Indicator

Abstract Purpose: Preoperative sarcopenia has been proved to be associated with worse postoperative outcomes in cancer patients. This study aimed to evaluate whether preoperative sarcopenia affects the perioperative outcomes, adjuvant chemotherapy, and long-term outcomes of patients with stage Ⅲ colon cancer.Methods: Total 218 patients who underwent curative resection for stage Ⅲ colon cancer in our department from January, 2015 and December, 2018 were retrospectively analyzed. Sarcopenia was assessed by total psoas index, which measured the total area the level of L3 vertebral body and normalized according to patients’ height. Perioperative complications, postoperative adjuvant chemotherapy, and long-term prognosis were retrospectively analyzed.Results: Of 218 patients, 100(45.9%) patients were diagnosed with sarcopenia. Sarcopenia did not add the risk of perioperative complications (20.0% vs 15.3%, P=0.357), but it increased hospital stays (7.6±3.9 vs 6.7±2.2 days, P=0.042). Patients with sarcopenia had a lower rate of receiving adjuvant chemotherapy (70.0% vs 82.2%, p=0.033) and less likely to receive adequate adjuvant chemotherapy (58.6% vs 70.1, P=0.08). Patients with adequate adjuvant chemotherapy had significantly better 3-year OS (89.8% vs 79.5, P=0.005) and a tendency of better 3-year DFS (76.4% vs 63.6%, P=0.055) than those with inadequate adjuvant chemotherapy and Non-adjuvant chemotherapy. Compared with the patients without sarcopenia, patients with sarcopenia had significantly worse 3-year DFS (76.9% vs 62.8%, P=0.026).Conclusion: Preoperative sarcopenia was an important indicator to predict the compliance of AC in stage Ⅲ colon cancer patients, and it is also a significant prognostic factor of worse 3-year DFS.

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