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The impact of colorectal screening program on the detection of right-sided colorectal cancer. A 5-year cohort study in the Mantua District

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Abstract

Background

High rates of advanced colorectal cancer (CRC) are still diagnosed in the right side of the colon. This study aimed to investigate whether screening programs increase CRC detection and whether tumor location is associated with survival outcome.

Methods

Patients affected by CRC, aged from 50 to 69 years and operated on from 2005 to 2009 were reviewed. Other than patient-, disease-, and treatment-related factors, detection mode and tumor location were recorded. Overall (OS) and disease-free survival (DFS) were investigated, using univariate and multivariate analyses.

Results

Mean age of 386 patients included was 62.0 years, 59 % were males. CRC was detected by screening in 17 % of cases, and diagnosis was made from symptoms in 67 % and emergency surgery for 16 %. Screen-detected CRCs were located in the left colon (59 %), then in rectum (25 %) and in proximal colon (16 %) (p = 0.02). Most of CRC patients urgently operated on had cancer located in proximal colon (45 %), then in the left colon (36 %) and in rectum (18 %) (p = 0.001). Right-sided CRC demonstrated higher pTNM stage (p = 0.001), adequate harvest count nodes (p = 0.0001), metastatic nodes (p = 0.02), and poor differentiation grading (p = 0.0001). With multivariate analysis, poor differentiation grade was independently associated with both worse OS (HR 3.6, p = 0.05) and worse DFS (HR 8.1, p = 0.0001), while distant recurrence was associated with worse OS (HR 20.1, p = 0.0001).

Conclusion

Low rates of right-sided CRC are diagnosed following screening program. Proximal CRC demonstrates aggressive behavior without impact on outcome. These findings prompt concern about population awareness for CRC screening.

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Acknowledgements

The authors are indebted to R. Buzzacchi, M.D., who contributed to study data collection but unfortunately passed away because of a sudden illness. We would not like to forget his professional skills and helpfulness. We are also grateful to the technicians and medical doctors at the pathology service for retrieving the histological data and to V. Pironi L. Gatti and L. Guarda, office workers and statistics at the Department of Epidemiology, for advice in collecting data from the Mantua District.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery and Orthopaedics, General Surgery Units of Asola, Mantua and Pieve C., Carlo Poma Hospital, 80° Fanteria Place, 1-46041, Asola, Mantua, Italy

    Corrado R. Asteria, Leonardo Gerard, Luigi Boccia & Coriolano Pulica

  2. Department of Surgery Oncology and Gastroenterology, Surgical Clinic I, School of Medicine, University of Padua, Padua, Italy

    Salvatore Pucciarelli

  3. Department of Surgery and Orthopaedics, Digestive Endoscopy Unit, Carlo Poma Hospital, Mantua, Italy

    Nicola Mantovani & Luigi Troiano

  4. Department of Medicine, Medicine Unit, Pieve Coriano, Carlo Poma Hospital Mantua, Mantua, Italy

    Mauro Pagani

  5. Epidemiological Observatory Local Health-care Authority (LHCA), Mantua, Italy

    Paolo Ricci

  6. Department of Healthcare Medical Management, Biostatistic Service, Carlo Poma Hospital, Mantua, Italy

    Giuseppe Lucchini

Authors
  1. Corrado R. Asteria
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  2. Salvatore Pucciarelli
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  3. Leonardo Gerard
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  4. Nicola Mantovani
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Correspondence to Corrado R. Asteria.

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Asteria, C.R., Pucciarelli, S., Gerard, L. et al. The impact of colorectal screening program on the detection of right-sided colorectal cancer. A 5-year cohort study in the Mantua District. Int J Colorectal Dis 30, 1627–1637 (2015). https://doi.org/10.1007/s00384-015-2352-1

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