Surgical Practices May Explain International Survival Differences in Cancer Treatment

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Overall, patient survival was not associated with surgical technique.
Overall, patient survival was not associated with surgical technique.

Poor colorectal cancer survival rates in some countries could be due to lower rates of surgical resection in those areas, particularly among elderly patients, according to findings from a retrospective, tumor-registry study published in The Lancet Oncology.1 Surgical techniques did not appear to correlate with survival rates in the comparative study of treatment patterns and patient outcomes in England, Denmark, Norway, and Sweden.

“Survival from colon cancer and rectal cancer in England and colon cancer in Denmark was lower than in Norway and Sweden,” the authors reported. “Survival paralleled the relative provision of resectional surgery in these countries. Differences in patient selection for surgery, especially in patients older than 75 years or individuals with advanced disease, might partly explain these differences in international colorectal cancer survival.”

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The study included data from a total of 139,457 adults diagnosed with primary invasive colorectal adenocarcinoma between 2010 and 2012. Overall, patient survival was not associated with surgical technique. Rates of surgical colon resection were 68% in England and 81% in Sweden, and 60% and 71% for rectal cancer, respectively. For patients aged 75 years and older, those differences were even more pronounced: 60% vs 81%, respectively, for colon cancer and 46% and 62%, respectively, for rectal cancer.

The registry data reviewed did not include comorbidities, however. The risk of perioperative morality should continue to be carefully assessed for each patient, cautioned Eva Angenete, MD, PhD, of the Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden, in a commentary published alongside the study.2

Tumor registries should be updated to include patient frailty and comorbidity data, the study authors and Dr Angenete noted. 


  1. Majano SB, Di Girolamo C, Rachet B, et al. Surgical treatment and survival from colorectal cancer in Denmark, England, Norway, and Sweden: a population-based study [published online December 10, 2018]. Lancet Oncol. doi: 10.1016/S1470-2045(18)30646-6
  2. Angenete E. The importance of surgery in colorectal cancer treatment [published online December 10, 2018]. Lancet Oncol. doi: 10.1016/S1470-2045(18)30646-6 

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