lncidence of Colorectal Cancer and Comparisons of Outcomes after Minimally Invasive and Open Surgery
Abstract
Aim: Surgery remains the mainstay of treatment for colorectal cancer. The aim of this thesis was to determine the overall incidence of colorectal cancer in Sweden over time and to evaluate surgical treatment comparing minimally invasive surgery including laparoscopic and robot assisted laparoscopic surgery to open surgery.
Methods: Paper I explores the overall incidence of colorectal cancer in Sweden over time. Papers II-IV report results from two population based cohort studies and a randomized controlled trial. The papers compare minimally invasive surgery including laparoscopic and robot assisted laparoscopic surgery to open surgery for colon and rectal cancer.
Results: Paper I found a decrease in the overall incidence of colorectal cancer in Sweden in the last decade, whilst the incidence in patients under the age of 50 years continued to increase. Paper II demonstrated favorable short-term outcomes following laparoscopic surgery compared to open surgery for colon cancer. Paper III showed that minimally invasive surgery for rectal cancer was non-inferior to open surgery with regard to adequate cancer resection with advantageous short-term outcomes. There were no long-term difference in risk of bowel obstruction, incisional, or parastomal hernia comparing the surgical techniques in patients with rectal cancer as reported in paper IV.
Conclusion: The overall incidence of colorectal cancer in Sweden has decreased in the last decade, despite an increase in the younger population. Surgical resection for colorectal cancer using minimally invasive technique is oncologically safe with favorable short-term outcomes compared to open surgery. No advantage was found following minimally invasive surgery for rectal cancer with regard to long-term risk of bowel obstruction, incisional and parastomal hernia.
Parts of work
1. Petersson J, Bock D, Martling A, Smedby KE, Angenete E, Saraste D. Increasing incidence of colorectal cancer among the younger population in Sweden BJS Open. 2020;4(4):645-658, https://doi.org/10.1002/bjs5.50279 2. Petersson J, Matthiessen P, Jadid KD, Bock D, Angenete E. Short term results in a population based study indicate advantage for laparoscopic colon cancer surgery versus open Sci Rep. 2023;16;13(1):4335, http://doi.org/10.1038/s41598-023-30448-8 3. Josefin Petersson, Peter Matthiessen, Kaveh Dehlaghi Jadid, David Bock, Eva Angenete. Short-term results in a population based study indicate advantage for minimally invasive rectal cancer surgery versus open 4. Petersson J, Koedam TW, Bonjer HJ, Andersson J, Angenete E, Bock D, Cuesta MA, Deijen CL, Fürst A, Lacy AM, Rosenberg J, Haglind E; COlorectal cancer Laparoscopic or Open Resection (COLOR) II Study Group. Bowel Obstruction and Ventral Hernia After Laparoscopic Versus Open Surgery for Rectal Cancer in A Randomized Trial (COLOR II) Ann Surg. 2019;269(1):53-57, http://doi.org/10.1097/SLA.0000000000002790
Degree
Doctor of Philosophy (Medicine)
University
University of Gothenburg. Sahlgrenska Academy
Institution
Institute of Clinical Sciences. Department of Surgery
Disputation
Fredagen den 19 januari 2024, kl. 13.00, Hörsal Arvid Carlsson, Academicum, Medicinaregatan 3, Göteborg
Date of defence
2024-01-19
josefinpetersson@hotmail.com
Date
2023-12-07Author
Petersson, Josefin
Keywords
colorectal cancer incidence
colon cancer
rectal cancer
surgery
Publication type
Doctoral thesis
ISBN
978-91-8069-551-0 (PRINT)
978-91-8069-552-7 (PDF)
Language
eng