Early Onset Colorectal Cancer epidemiology surgical outcomes survival and quality of life after surgery

Abstract

Early-onset colorectal cancer (EOCRC) is the diagnosis of colorectal cancer <50 years and is increasing in incidence worldwide, with Australia at the forefront. Existing research is based on American cohorts and minimal studies investigate the postoperative outcomes, survival and health-related quality of life (HRQoL) of EOCRC patients. This thesis aimed to summarise the current literature and to report on the postoperative outcomes, survival and the HRQoL of an Australian cohort of EOCRC patients.

A retrospective audit showed that most patients presented with left-sided and stage IV disease. Pelvic exenteration (PE) or cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) were performed in nearly one-third of the cohort, closely followed by low anterior resections. The rate of stoma formation and postoperative minor complications was high. However, the absolute five-year survival rate was 85.5%. A cross-sectional study utilising the SF-36v2 survey found that the physical and mental aspects of HRQoL were within the average range of the general Australian population. Although insignificant, the mental component summary (MCS) scores were below the mean MCS scores of the general Australian population ≤2 and >2 years after surgery. Having stage I disease and an emergency index operation conferred poorer physical component summary (PCS) scores ≤2 years from surgery.

These findings can inform multidisciplinary team discussions, expedite referrals to quaternary services for select patients who require PE or CRS and HIPEC, guide preoperative surgical consultations and highlight the need for postoperative follow-up with psychologists and psychiatrists. Future research should compare the surgical and functional outcomes of EOCRC to later-onset colorectal cancer (LOCRC), investigate the cost-effectiveness of reducing the colorectal cancer screening initiation age and focus on identifying minimally invasive diagnostic biomarkers for EOCRC.