Stage migration in curative colorectal cancer resections
Abstract
Introduction
The NHS Bowel Cancer Screening Programme (BCSP) introduced in 2006 aimed at detecting pre-malignant colorectal disease in patients aged >60 years. We assessed the impact of screening on Dukes Stage presentation in patients undergoing curative colorectal resections.
Method
All patients undergoing curative resection between January 2008 and January 2012 were assessed. Demographics, age of diagnosis and histological Duke's Stage were analysed.
Results
467 patients were identified. Median age was 69, male to female preponderance of 1.67:1. The total number of curative resections ranged from 111-123 (mean 117). A significant decrease in Dukes A cancers from 32.2% in 2008 to 15.5.% in 2012. (p=0.0024 chi-square) was observed. Dukes B cancers increased from 26.3% to 38% (p=0.05 Chi-square). An increase in Dukes C cancers by 4.9% was demonstrated, however this did not attain statistical significance (p=0.516 chi-square).
Conclusions
Dukes A disease has decreased but with a steady rise in Dukes B and C cancers in our cohort. The total number of annual curative resections remains unchanged. Stage migration to more advanced disease in curative resections may be attributable to more aggressive endoscopic treatment of premalignant adenomatous disease. Evaluation in larger cohorts is needed, which may necessitate screening in younger patients.
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