Abstract
Introduction
“Natural history”, or anticipated survival without treatment, is critical for patients
weighing risks and benefits of cancer surgery. Current estimates concerning the natural
history of cancer includes patients whose poor health precludes treatment; a cohort
whose fate is likely distinctly worse than those eligible for surgery (“operable”).
The study objective was to evaluate survival among patients recommended for cancer
surgery but went untreated, to determine the natural history of “operable” alimentary
tract cancer.
Methods
The NCDB was queried for untreated patients with clinical stage I–III esophageal,
gastric, colon, and rectal cancer diagnosed between 2003 and 2009. Untreated patients
who were recommended for surgery were considered “operable,” while patients coded
as surgically ineligible for health reasons were “inoperable.”
Results
5-year survival of untreated, “operable” alimentary tract cancers varied by clinical
stage: esophageal cI = 10.0%, cII = 9.8%, cIII = 4.6%; gastric cI = 9.2%, cII = 5.8%,
cIII = 4.3%; colon cI = 18.4%, cII = 5.0%, cIII = 10.4; and rectal cI = 17.1%, cII = 14.0%,
cIII = 19.9%. At every timepoint, stage-specific survival of “operable” patients was
superior to inoperable patients (p < 0.05). Additionally, median survival among “operable”
patients at least doubled “inoperable” patients for each tumor.
Conclusion
Natural history of patients with “operable” alimentary tract cancer is superior to
that of “inoperable” patients. Preoperative counseling should be refined to reflect
this distinction.
Keywords
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Article info
Publication history
Published online: January 18, 2017
Accepted:
December 6,
2016
Identification
Copyright
© 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
