Trends in resection rates and postoperative mortality for gastrointestinal cancers between 2005 and 2020 in the Netherlands
Menée aux Pays-Bas sur la période 2005-2020, cette étude de cohorte rétrospective analyse l'évolution du taux de résections des cancers gastro-intestinaux et l'évolution de la mortalité postopératoire
Aim: This study assesses trends in resection rates and postoperative mortality for oesophageal, gastric, colon, rectal, periampullary and pancreatic cancer in the Netherlands.
Methods: This retrospective cohort study included all patients with gastrointestinal cancer diagnosed in the period 2005-2020 as registered in the Netherlands Cancer Registry. Cochran-Armitage trend tests were used to assess trends in resection rates. Multivariable logistic regression analyses were used to assess the association between time period and resection rates and postoperative mortality and were stratified for nonmetastatic versus metastatic disease at initial diagnosis.
Results: A total of 226 925 patients with nonmetastatic and 92 343 with metastatic disease were included. A lower likelihood of undergoing resection was observed for patients diagnosed between 2017-2020 as compared to 2005-2008 for nonmetastatic colon (OR=0.73; 95%CI:0.68-0.79) and rectal cancer (OR=0.44; 95%CI:0.40-0.48). In contrast, higher resection rates were observed for nonmetastatic gastric (OR=1.17; 95%CI:1.03-1.32), periampullary (OR=2.44;95%CI:2.09-2.84) and pancreatic cancer (OR=2.81; 95%CI:2.51-3.15 comparing the same time periods). Patients with nonmetastatic disease diagnosed in 2017-2020 had a lower likelihood of 90-day postoperative mortality compared to 2005-2008 for all cancer types with ORs ranging between 0.27 (95%CI:0.22-0.33, rectal cancer) and 0.60 (95%CI:0.43-0.84, periampullary cancer). In colon and rectal cancer patients presenting with metastatic disease, resection rates and postoperative mortality significantly decreased over time.
Conclusion: Resection rates decreased for some gastrointestinal cancer types possibly due to the introduction of treatment strategies without resection (e.g. watchful waiting). Postoperative mortality decreased for all patients, possibly as a result of increased quality of care, and improved patient selection.
European Journal of Cancer , résumé 2025