Predictive Significance of Tumour Size in Patients Undergoing Curative Surgery for Colorectal Cancer: A Retrospective Cohort Study

Objectives

To evaluate the predictive significance of tumour size in patients undergoing curative surgery for colorectal cancer (CRC).

Methods

All patients undergoing curative surgery for colon or rectum cancer performed by a single colorectal surgeon between January 2013 and January 2020 were considered eligible for inclusion. Linear and binary logistic regression analyses were modelled to assess whether colonic or rectal tumour size could predict R0 resection, specimen length, number of harvested and positive lymph nodes, lymphocytic infiltration, venous invasion, and overall survival.

Results

A total of 192 patients were eligible for inclusion. In patients with colon cancer, tumour size was the independent predictor of the number of harvested lymph nodes (P<0.001), the number of positive lymph nodes (P=0.001), and lymphocytic infiltration (P=0.009). However, it did not predict R0 resection (P=0.563), specimen length (P=0.111), specimen length >120 mm (P=0.186), >12 harvested lymph nodes (P=0.145), venous invasion (P=0.103), and five-year overall survival (P=0.543). In patients with rectal cancer, tumour size was the independent predictor of the number of harvested lymph nodes (P<0.001) and the number of positive lymph nodes (P<0.001). However, it did not predict R0 resection (P=0.108), specimen length (P=0.774), specimen length >120 mm (P=0.405), >12 harvested lymph nodes (P= 0.069), lymphocytic infiltration (P=0.912), venous invasion (P= 0.105), and five-year overall survival (P=0.413).

Conclusions

The results of the current study suggest that tumour size on its own may not have a significant predictive value in oncological or survival outcomes in patients undergoing curative surgery for colon or rectum cancer.

Editor's Choice - Systematic Review and Meta-Analysis of Very Urgent Carotid Intervention for Symptomatic Carotid Disease

BACKGROUND

The optimum timing of carotid intervention for symptomatic carotid stenosis remains unclear. The objective was to investigate outcomes of very urgent (< 48 h from neurological event) in comparison to urgent (≥ 48 h from neurological event) carotid intervention for symptomatic carotid disease.

METHODS

A systematic literature review was carried out of randomised control trials (RCTs) and observational studies reporting peri-procedural outcomes of carotid intervention in relation to the length of time since the neurological event (PROSPERO registration number: CRD 42017075766). Ipsilateral stroke and death were defined as the primary outcome endpoints. Transient ischaemic attack (TIA) and myocardial infarction (MI) were secondary outcome parameters. Comparative outcomes were calculated and reported as dichotomous outcome measures using the odds ratio (OR) and associated 95% confidence interval (CI) for very urgent (< 48 h since neurological event) versus urgent (≥ 48 h) intervention. The combined overall effect size was calculated using a random effects model.

RESULTS

Twelve observational studies and one RCT representing 5751 interventions, 5385 carotid endarterectomies (CEAs) and 366 carotid artery stenting (CAS) procedures, were included in quantitative synthesis. Very urgent carotid intervention was associated with increased risk of stroke within 30 days of treatment compared with urgent carotid intervention (OR 2.19, 95% CI 1.46-3.26, p < .001). No significant difference was found in mortality (OR 1.55, 95% CI 0.81-2.96, p = .19), TIA (OR 1.33, 95% CI 0.55-3.19, p = .52) or MI (OR 1.33, 95% CI 0.41-4.33, p = .64).

CONCLUSIONS

Very urgent carotid intervention was found to be associated with increased risk of stroke.