Bowel cancer huge difference in survival rates between surgery and non-surgery patients

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Bowel cancer: national audit confirms for the first time huge difference in survival rates between surgery and non-surgery patients

Patients who have operation almost twice as likely to live two years beyond diagnosis

Strictly embargoed to 00:01 3 July 2013: embargoed copies of report available on request

*Regional information available from this audit

Unprecedented research involving more than 50,000 bower cancer patients by the National Bowel Cancer Audit shows for the first time today that four in five patients who underwent major surgery in England and Wales between April 2008 and March 2010 lived beyond two years of diagnosis.

Over the same period, those patients who were either too frail to have a major surgery and/or had too advanced cancer to benefit from major surgery had a much poorer survival rate, with only two of five patients surviving for two years.  This contrast in outcomes means further investigations are required to better define the reasons why some patients do not have major surgery.

The audit has been developed by the Association of Coloproctology of Great Britain and Ireland, the Health and Social Care Information Centre (HSCIC) and the Royal College of Surgeons of England, and commissioned by the Healthcare Quality Improvement Partnership.

Today’s audit report also presents new data about 90 day post-operative survival based on the records of nearly 30,000 people diagnosed with bowel cancer between April 2011 and March 2012.

It found post-operative survival is at an all-time high. Of the 17,250 patients who had surgery, 16,450 – or 95.5 per cent – were alive 90 days on from their operation – compared to 94.7 per cent in 2010/11 and 93.9 per cent in 2008/09.

This documented reduction in 90 day surgical mortality by nearly one third (6.1 per cent to 4.5 per cent) in only four years represents dramatic progress in patient selection and postoperative care employed by the multidisciplinary teams managing bowel cancer inEnglandandWales.

However, the risk of post-operative death following an emergency admission carries a much higher risk when compared to an admission for elective (planned) surgery.    About one in seven patients undergoing emergency surgery in 2011/12 did not survive 90 days after operation.

The audit also found:

The proportion of patients admitted to hospital as an emergency case (as opposed to an elective case) has not changed significantly in four years, remaining at what clinicians describe as a “stubborn” 21 to 22 per cent. This equated to 5,250 patients diagnosed in 2011-2012. The proportion of major operations that were “keyhole” (laparoscopic) continues to increase- from a quarter of operations in 2008/09 to more than 40 per cent in 2011/12. “Keyhole” surgery for selected cases of bowel cancer is associated with a shorter hospital stay, smaller scars and faster return to normal activity. Nigel Scott, audit clinical lead and consultant colorectal surgeon at the Royal Preston Hospital, said: “The National Bowel Cancer Audit has demonstrated some very positive progress in the management of bowel cancer by specialised teams of surgeons, oncologists, nurse specialists, radiologists, pathologists and anaesthetists in England and Wales.  Correct patient selection and postoperative care has delivered a fall in postoperative mortality of one third in just a few years.

“In addition these better outcomes immediately after surgery are matched by 80 per cent of patients surviving at least two years or more – a testimony to bowel cancer multidisciplinary working inEnglandandWales.  Alongside all of this progress the widespread adoption of laparoscopic (keyhole) operations represents another success story for bowel cancer care in these countries.

“The downside continues to be the much poorer outcomes associated with not operating because of advanced disease.  Blood, bowels and poo tend to get sat on, as embarrassment puts people off from seeing the doctor.  Getting past the bathroom door and seeking the support of a health professional is the best means of finding a cancer as soon as possible

“A related problem is the late emergency admission with a blocked bowel.  These emergency bowel cancer patients tend to be older and frailer and out-of-hours provision of services, including interventional radiology and stenting, are patchy.”

Pictured above is former Everton FC footballer Kevin Sheedy who survived bowel cancer.

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