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Detrimental impact of symptom-detected colorectal cancer



The incidence and mortality rates of colorectal cancer (CRC) have been steadily decreasing, largely attributable to screening colonoscopies that either remove precancerous lesions or identify CRC earlier. We aimed to assess the prognostic difference between colorectal cancers diagnosed by screening (SC), diagnostic (DC), or surveillance (SU) colonoscopies.


All 1809 surgically treated patients with primary CRC diagnosed through colonoscopy at our tertiary center (2004–2015) were extracted from a prospectively maintained database. Oncologic outcomes were compared, including multivariate Cox regression.


Diagnostic patients presented with more advanced disease (15.0% vs. 53.2% (SC) and 55.3% (SU) AJCC I, P < 0.001), subsequently leading to impaired survival and higher recurrence rates (P < 0.001). After adjustment for age, ASA-score and gender, oncologic outcomes remained significantly worse after DC. Hazard ratios (HR) of overall mortality (OS) compared to DC were 0.36 for SC and 0.58 for SU (P < 0.001). Adjusted HRs of disease-free survival (DFS) were 0.43 and 0.32, respectively (P < 0.001). Worse outcomes in OS withstood adjustment for stage, tumor site and (neo)adjuvant treatment (SC: HR 0.46, P < 0.001; SU: HR 0.73, P = 0.036). The benefits of SC were particularly seen in colon cancer, stages I–II and female patients. With regard to DFS, outcomes were less profound and mainly true in early stage disease and surveillance patients.


This study demonstrates the enormous impact of asymptomatic screening in CRC. Patients with CRC diagnosed through screening or surveillance had a significantly better prognosis compared to patients who presented symptomatically. This emphasizes the importance of screening.

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American Cancer Society


American Joint Committee on Cancer


American Society of Anesthesiologists


Body Mass Index, kg/m2


Carcinoembryonic Antigen


Confidence Interval


Colorectal Cancer


Computed Tomography


Diagnostic Colonoscopy


Disease-free Survival


Fecal Occult Blood Testing


Hazard Ratio


Inflammatory Bowel Disease


Interquartile Range


National Comprehensive Cancer Network


Overall Survival


Standard Deviation


Screening Colonoscopy


Surveillance Colonoscopy


Tumor Node Metastasis classification


US Preventive Services Task Force


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All authors have contributed to this manuscript in the following way: substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of the data. Furthermore, all authors drafted or revised the manuscript critically for important intellectual content. All authors approved the final version and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to David L. Berger.

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Lieve Leijssen, Anne Dinaux, Hiroko Kunitake, Liliana Bordeianou, David Berger have no conflicts of interest or financial ties to disclose.

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Leijssen, L.G.J., Dinaux, A.M., Kunitake, H. et al. Detrimental impact of symptom-detected colorectal cancer. Surg Endosc 34, 569–579 (2020).

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