By Christina Frangou

First Look: The American Society of Colon and Rectal Surgeons

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The American Society of Colon and Rectal Surgeons (ASCRS) held its 2021 meeting virtually this spring. Here, General Surgery News presents one of the top papers from the meeting.

A new analysis suggests that patients with multiple high-risk features in the presence of stage II colon cancer have worse survival than patients with stage III disease.

High-risk features “have a cumulative effect in stage II colon cancer,” said study author Brian Herritt, MD, a fifth-year resident in general surgery at Louisiana State University Health Sciences Center New Orleans.

These features include T4 lesions, perineural invasion, poor lymph node sampling of 12 nodes or fewer, and poor histologic differentiation.

Using the SEER×Stat database, Dr. Herritt and his colleagues compared the overall and relative survival in five-year intervals of patients with stage II disease who were low risk, had one high-risk feature, or had two or more high-risk features, as well as patients with stage III disease. The study included 65,828 patients.

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As expected, patients with low-risk stage II disease had the highest five-year relative survival at 90%. This dropped to 82% among stage II patients with one high-risk feature. But stage II patients with multiple high-risk features had a marked drop in five-year relative survival—down to 59%—faring worse than stage III patients who had a relative survival of 68% at five years.

“I think this fairly definitely demonstrates that patients with stage II disease and high-risk features warrant additional treatment after surgery with curative intent,” Dr. Herritt said.

No single high-risk feature approached the mortality associated with multiple features. However, the worst survival in the study population for a single high-risk feature was inadequate nodal sampling at 62%.

Dr. Herritt said more research is needed to delineate the role that chemotherapy will play in patients with high-risk stage II disease. Right now, there is no consensus on use of chemotherapy in stage II disease. Multiple regimens have been proposed based on an individual’s risk factors, but there is no agreed-upon strategy.

Dr. Herritt said specific databases should be created to collect data on individual risk factors, clinical and genetic information, and patient outcomes.

The study was recognized with the General Surgery Forum Best Paper Award.

This article is from the July 2021 print issue.