Abstract
Background
The incidence of rectal cancer in young Indians is increasing. Recent evidence suggests a probable existence of noncanonical tumorigenesis pathways in early-onset colorectal cancer patients in India. The aim of the study was to evaluate rectal cancer outcomes in patients ≤40 years with those >40 years.
Methods
An analysis of a prospective database of surgically treated rectal cancer patients ≤40 years (group 1) and those >40 years (group 2) over 2 years was performed. Clinicopathological features, perioperative outcomes, and disease-free survival (DFS) were analyzed.
Results
Of the 512 patients with colorectal cancer treated surgically, 237 patients (group 1—57 patients; group 2—180 patients) were diagnosed with nonmetastatic rectal adenocarcinoma. Patients in group 1 were more likely to present with locally advanced (stage III) disease (p < 0.005) resulting in a higher proportion of them receiving neoadjuvant chemoradiotherapy (NACT-RT). There was no difference in morbidity and mortality between the two groups. Younger patients had a significantly higher median total and positive lymph node yield (p < 0.003). Patients in group 1 had a significantly lower overall DFS (p < 0.005). Stage-specific DFS also demonstrated a significantly lower trend in stage III patients in group 1.
Conclusions
Young rectal cancer patients in India tended to present more frequently with locally advanced tumors resulting in a higher proportion being treated with NACT-RT. Stapled rectal anastomoses could be performed safely in young patients even after NACT-RT. The significantly poorer DFS in young Indian patients with stage III disease was a novel finding and merits further investigation into tumor biology.
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Barreto, S.G., Chaubal, G.N., Talole, S. et al. Rectal cancer in young Indians—Are these cancers different compared to their older counterparts?. Indian J Gastroenterol 33, 146–150 (2014). https://doi.org/10.1007/s12664-013-0396-0
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DOI: https://doi.org/10.1007/s12664-013-0396-0