Outcome of Operated Colorectal Cancers in Relation to the Type of Initial Referral

Mahmoud Elnaggar; Ponnuthurai Pratheepan; Baskaran Paramagurunathan; Josie Colemeadow; Basim Hussein; Varvara Bashkirova; Kavya Pillai; Lucy Singh; Mehar Chawla

doi:10.7759/cureus.36840

Outcome of Operated Colorectal Cancers in Relation to the Type of Initial Referral

Cureus. 2023 Mar 29;15(3):e36840. doi: 10.7759/cureus.36840. eCollection 2023 Mar.

Authors

Mahmoud Elnaggar¹, Ponnuthurai Pratheepan², Baskaran Paramagurunathan², Josie Colemeadow², Basim Hussein², Varvara Bashkirova², Kavya Pillai², Lucy Singh², Mehar Chawla²

Affiliations

¹ Colorectal Surgery, North Middlesex University Hospital NHS Trust, London, GBR.
² General Surgery, North Middlesex University Hospital NHS Trust, London, GBR.

Abstract

Aim Since the introduction of the target referral system, there has been controversy about its value and whether it affected the short- and long-term outcomes of colorectal cancer surgeries. With contradicting results, this study highlights differences in personal and tumour characteristics, management differences, and outcomes in each referral pathway, including target pathway referrals for suspected cancers, emergency presentations, routine referrals, and incidentally discovered cancers during screening. Methods A retrospective study of colorectal cancer (CRC) patients operated on between January 1, 2010, and December 31, 2014, with records dating to the end of the five-year follow-up, was extracted anonymously from the database of CRC outcomes at the North Middlesex University Hospital NHS Trust, London. The total number of patients operated on through the four pathways was 176, with full records and competent follow-ups. Patients were classified according to the mode of referral: two-week wait (2WW or target), routine, emergency, and incidental discovery referrals. Comparisons were made between these groups with regard to personal and tumour characteristics, management, and outcome. Results It has been demonstrated by this study that target referrals present mainly with stage I cancers as compared to emergency referrals that present with more stage II (IIa+ IIb+ IIc). The highest percentage of cancer locations within the large bowel was rectal, followed by sigmoid in both target and emergency groups; 8.8% of target patients needed neoadjuvant chemoradiotherapy in the form of FOLFOX (folinic acid, 5-fluorouracil, and oxaliplatin) chemotherapy protocol with the addition of radiotherapy in patients with advanced rectal cancers, compared to 13.3% of emergency patients. Conclusion The colorectal 2WW system was the main pathway supplying colorectal cancer operations; it mostly showed earlier cancers than the other referral groups; its cancers were mostly rectosigmoid with less need for adjuvant chemotherapy; fewer recurrences; and it also showed a lower five-year mortality rate than the emergency group.

Keywords: cancer; colorectal; colorectal cancer; referral; surgery; target; target referral; two week wait.