Early-onset colorectal cancer diagnosed before age 50 years is often found at an advanced stage but an aggressive surgical approach can achieve acceptable five-year absolute survival rates, Australian research shows.
A retrospective study of 111 EOCRC patients treated at Sydney’s Royal Prince Alfred Hospital (RPAH) between January 2013 and December 2021 has found absolute survival rates were 93.69%, 87.39% and 85.48% at one-, three- and five years, respectively.
RPAH is a quaternary referral centre for pelvic exenteration (PE) and cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC).
The study, published in the ANZ Journal of Surgery [link here], comprised men and women with an average age of 38 years.
Most tumours (80%) were left-sided with a nearly equal distribution between tumours located between the splenic flexure and sigmoid colon and those located in the rectum.
More than a third of patients (37.84%) were diagnosed with stage IV disease at the time of presentation while 30.63% had stage III, 18.02% had stage II and 13.51% had stage I disease.
The study reported that 27.93% underwent either CRS/HIPEC (15.32%) or PE (11.71%) for their primary surgery.
Otherwise, the most frequent procedures were low anterior resection (19.82%), high anterior resection (17.12%) and right hemicolectomy (14.41%).
ICU admission was required in 40.54% of patients overall with a mean duration of 5.80 days while 9.01% of patients overall required a return to theatre.
Complications occurred in 54.95% patients overall and were mostly grade II.
When comparing the surgical outcomes from more aggressive procedures of CRS/HIPEC or PE versus other procedures:
- ICU admission – 100% v 17.5%
- Requirement for total parenteral nutrition – 93.5% v 6.25%
- Length of hospital stay – 27 days v 11 days
- Complications – 77.42% v 46.25%
- Return to theatre <30 days – 12.9% v 7.5%
- Stoma formation – 58.06% v 47.50%
There were no deaths within 30 days of surgery.
“Disease recurrence occurred in 38.74% of the patients (n = 43/111) and their median DFS [disease-free survival] was 13.90 (IQR: 7.20–29.30) months,” the study said.
“After adjusting for stage, an adverse DFS and OS [overall survival] were demonstrated for PE followed by CRS/HIPEC then other colorectal resections for patients with stage IV disease (P < 0.001 and P = 0.003, respectively).”
“This result is not surprising and is explained by the relatively smaller disease burden of non-CRS/ HIPEC or PE patients and the enhanced cytotoxicity from direct exposure to heated chemotherapy in the CRS/HIPEC group which has been shown to confer a survival benefit.”
The investigators, led by Dr Celine Garrett, said the study was the first to describe surgical treatment patterns and outcomes of an Australian EOCRC cohort that included a subset of patients who had undergone CRS/HIPEC and PE.
“Whilst CRS/HIPEC and PE were associated with poorer stage-matched DFS and OS in comparison to other colorectal resections, the overall 5-year absolute survival in this cohort was good (86.48%),” they said.
“This highlights that in appropriately selected EOCRC patients who have been referred to a quaternary hospital specialising in CRS/HIPEC or PE, these can be performed with acceptable survival with the trade-off of high rates of stoma formation and minor postoperative complications.”
Data on quality of life and functional outcomes of EOCRC patients is yet to be published.