1. Prognosis of colon cancer compared with rectal cancer. Where lies the difference? Bjørn S. Nedrebø Stavanger University Hospital

2. Aim of the lecture Compare colon and rectal cancer in Norway Point out differences, short term and long term Quality of the surgical specimen of colon cancers in Norway

3. 3 National Registry Introduction TME 1993/94 Colon Cancer R x T4, fixed 20001997 C x Stage III ≤75 yrs 2003 MRI staging CRM ≤3 mm MDT Rectal Cancer Colorectal Cancer in Norway Evolution of Treatment Recommendations Colorectal Cancer in Norway Evolution of Treatment Recommendations

4. N=31158 (100%) Metachronous cancer; n=1486 (5%) N=29672( 95%) N=20648 (66%) Metastases; n=9024 (29%) Minor resections; N=1595 (5%) Study population N=19053 (61%) Patient Cohort Norwegian Cancer Registry & Rectal Cancer Registry, 1994 – 2003

5. Method 5 year relative survival for all patients Excess mortality in different timeperiods Time periods (1) 1994-1996 (N=5400) (2) 2001-2003 (N=5870) 70% Colon cancer in both periods

6. Analysis –Localisation Rectum (≤ 15 cm from anal verge) Colon –Stage N0 (T1-4, N0) N+ (T1-4, N1-2) –Age: <75 vs. ≥75 year

7. Patient Characteristics Sex (males, %) 48%49%n.s Age > 75 yrs37%42%<0.001 Stage N0 N+ 68% 32% 62% 38% <0.001

8. Improved survival Colon and rectal cancer p<0.01 Colon Rektum 1994-1996 2001-2003

9. Fig 1 a-b: Early studyperiod vs late studyperiod 1a Colon cancer 1b Rectal cancer

10. Colon vs rectum p<0.74 p<0.03 Early period Late period Colon Rectum

11. Fig 2 a-b. Coloncancer vs rectumcancer 2a Early period 2b Late period

12. Colon early vs late N0 N+ 1994-1996 2001-2003

13. Rectal cancer, early vs late N0 N+ 1994-1996 2001-2003

14. N+

15. Lymph node sampling as a proxy of surgical technique Included all patients in Norway 2007-2008 who were operated for adenocarcinoma in colon Lymph node sampling; % operations with ≥12 lymph nodes. 5068 coloncancer (100%) 4145 (81%) underwent surgical resection. 3733 patients (73%) with complete histopathologydata 73% ≥ 12 lymph nodes 16% laparoscopy

16. Age N≥12 lymph nodes <6526%74% 65-6913%74% 70-7415%66% 75-7917%66% 80-8416%65% >8513%66%

17. Sex/localisation SexN≥ 12 lymph nodes Male47%67% Female53%70% Right colon56%74% Left colon44%63%

18. Hospital volume Hospital volume / yearN% ≥ 12 lymph nodes >6059%71% 40-5926%69% 20-395%58% 10-207%66% <103%60%

19. Elective vs acute N≥ 12 lymph nodes Elective84%72% Acute w/ obstruction11%64% Acute w/ perforation<1%64%

20. Multivariatanalyse ≥12 lymph nodes: Pasient <70 years Elective surgery High volume hospital pT >1 Right sided resection Pathological template

21. Conclusion Better survival for rectal cancer than colon cancer Need to focus on colon cancer, especially patients over 75 years acute surgery high volume hospitals(?) standardised pathology template