The importance of surgery in colorectal cancer treatment
Menée à partir des données des registres nationaux danois, anglais, norvégien et suédois portant sur un total de 139 457 patients adultes atteints d'un adénocarcinome colorectal invasif, cette étude compare les taux de survie des différents pays puis analyse la corrélation entre ces taux de survie et la proportion de patients ayant subi une résection chirurgicale
In The Lancet Oncology, Sara Benitez Majano and colleagues have engaged with a very important topic. Previous data have indicated poorer treatment results for colorectal cancer in both Denmark and England compared with those in similar western countries. The continuous audit and assessment of outcomes is important to better understand the reality of cancer care each country and thus, this study is of interest to the public. Majano and colleagues identified that an important difference between the countries studied regarding surgery for colorectal cancer was probably not the technique, but rather the frequency of surgical resection. The proportion of patients treated with resectional surgery ranged from 68·4% in England to 81·3% in Sweden for colon cancer, and from 59·9% in England to 70·8% in Sweden for rectal cancer; this range was wider for patients older than 75 years (colon cancer 59·7% to 80·9%; rectal cancer 45·7% to 61·9%). What are the implications from these results? Majano and colleagues' paper highlights the importance of surgery in the treatment of colorectal cancer. It is possible that attitudes towards surgery in the older patient population should be altered in England, but the data in this study do not include comorbidity, and the risk for increased perioperative mortality should not be underestimated. It is important to continue to assess results of resectional surgery to avoid doing more harm than good. Preoperative optimisation of patients must be a focus of research, to increase the percentage of patients that are able to undergo resectional surgery in the future.
The Lancet Oncology , commentaire en libre accès, 2017