Association Between Colorectal Cancer Screening and Survival in Patients Older Than 70 Years: Results of A National...

Colorectal cancer screening mainly targets a population between 50 and 70 years of age; however, it is inconsistently implemented in people over 70. The aim of this study was to analyze the association between colorectal cancer (CRC) screening, postoperative mortality, and perioperative and oncologic outcomes in a large population of patients over 70 years of age who underwent surgery for CRC.

Data regarding people over 70 who underwent CRC surgery were retrieved from a nationally validated retrospective database, including four consecutive years (2018-2021) and 81 centers. The patients were divided into two groups according to their participation in the CRC screening program: Screening versus No Screening. The outcomes of the study were 30-day mortality; urgent, palliative and minimally invasive surgery rates; Clavien-Dindo ≥ III; advanced oncologic stage; R0 resection and length of hospital stay (LOS). Logistic regression analysis was carried out and adjusted for multiple confounders.

Of the 10,346 patients over 70,676 were in the screening group, and 9670 were in the no screening group. At logistic regression, CRC screening was significantly associated with a reduction in 30-day mortality (OR 0.41, 95% CI 0.18-0.92, p = 0.032), urgent surgery (OR 0.06, 95% CI 0.02-0.14, p < 0.001), palliative surgery (OR 0.32, 95% CI 0.19-0.54, p < 0.001), Clavien-Dindo ≥ III complications (OR 0.69, 95% CI 0.51-0.93, p = 0.016) and advanced oncologic stage (OR 0.53, 95% CI 0.45-0.62, p < 0.001), and a significant increase in R0 resections (OR 3.15, 95% CI 1.67-5.94, p < 0.001) and laparoscopic surgery (OR 1.93, 95% CI 1.57-2.38, p < 0.001). The crude and adjusted Odds Ratio similarity confirmed this correlation, regardless of the comorbidities and confounders.

Adherence to CRC screening should be further encouraged and standardized for people over 70.