H B Keshava1, J E Rosen2, M R DeLuzio3, A W Kim2, F C Detterbeck2, D J Boffa4. 1. Yale School of Medicine, Department of Thoracic Surgery, USA; Cleveland Clinic Foundation, Department General Surgery, USA. 2. Yale School of Medicine, Department of Thoracic Surgery, USA. 3. Yale School of Medicine, Department of General Surgery, USA. 4. Yale School of Medicine, Department of Thoracic Surgery, USA. Electronic address: Daniel.boffa@yale.edu.
Abstract
INTRODUCTION: "Natural history", or anticipated survival without treatment, is critical for patients weighing risks and benefits of cancer surgery. Current estimates concerning the natural history of cancer includes patients whose poor health precludes treatment; a cohort whose fate is likely distinctly worse than those eligible for surgery ("operable"). The study objective was to evaluate survival among patients recommended for cancer surgery but went untreated, to determine the natural history of "operable" alimentary tract cancer. METHODS: The NCDB was queried for untreated patients with clinical stage I-III esophageal, gastric, colon, and rectal cancer diagnosed between 2003 and 2009. Untreated patients who were recommended for surgery were considered "operable," while patients coded as surgically ineligible for health reasons were "inoperable." RESULTS: 5-year survival of untreated, "operable" alimentary tract cancers varied by clinical stage: esophageal cI = 10.0%, cII = 9.8%, cIII = 4.6%; gastric cI = 9.2%, cII = 5.8%, cIII = 4.3%; colon cI = 18.4%, cII = 5.0%, cIII = 10.4; and rectal cI = 17.1%, cII = 14.0%, cIII = 19.9%. At every timepoint, stage-specific survival of "operable" patients was superior to inoperable patients (p < 0.05). Additionally, median survival among "operable" patients at least doubled "inoperable" patients for each tumor. CONCLUSION: Natural history of patients with "operable" alimentary tract cancer is superior to that of "inoperable" patients. Preoperative counseling should be refined to reflect this distinction.
INTRODUCTION: "Natural history", or anticipated survival without treatment, is critical for patients weighing risks and benefits of cancer surgery. Current estimates concerning the natural history of cancer includes patients whose poor health precludes treatment; a cohort whose fate is likely distinctly worse than those eligible for surgery ("operable"). The study objective was to evaluate survival among patients recommended for cancer surgery but went untreated, to determine the natural history of "operable" alimentary tract cancer. METHODS: The NCDB was queried for untreated patients with clinical stage I-III esophageal, gastric, colon, and rectal cancer diagnosed between 2003 and 2009. Untreated patients who were recommended for surgery were considered "operable," while patients coded as surgically ineligible for health reasons were "inoperable." RESULTS: 5-year survival of untreated, "operable" alimentary tract cancers varied by clinical stage: esophageal cI = 10.0%, cII = 9.8%, cIII = 4.6%; gastric cI = 9.2%, cII = 5.8%, cIII = 4.3%; colon cI = 18.4%, cII = 5.0%, cIII = 10.4; and rectal cI = 17.1%, cII = 14.0%, cIII = 19.9%. At every timepoint, stage-specific survival of "operable" patients was superior to inoperable patients (p < 0.05). Additionally, median survival among "operable" patients at least doubled "inoperable" patients for each tumor. CONCLUSION: Natural history of patients with "operable" alimentary tract cancer is superior to that of "inoperable" patients. Preoperative counseling should be refined to reflect this distinction.
Authors: Hari B Keshava; Andrew Tang; Hafiz Umair Siddiqui; Siva Raja; Daniel P Raymond; Alejandro Bribriesco; James Stevenson; Sudish C Murthy; Usman Ahmad Journal: World J Surg Date: 2019-12 Impact factor: 3.352
Authors: Alona Courtney; Ann-Marie Howell; Najib Daulatzai; Nicos Savva; Oliver Warren; Sarah Mills; Shahnawaz Rasheed; Goel Milind; Nicholas Tekkis; Matthew Gardiner; Tinglong Dai; Bashar Safar; Jonathan E Efron; Ara Darzi; Paris Tekkis; Christos Kontovounisios Journal: Int J Surg Protoc Date: 2020-08-11