Trends over time and inter-hospital variation in the primary treatment approach for T1 colon carcinomas in the Netherlands

BACKGROUND AND STUDY AIMS This study evaluates the use of local resections (LR) as initial treatment versus primary surgery (PS) for T1 colon carcinoma (CC) in the Netherlands over time, hospital variations, and whether changes in treatment approaches impact 5-year relative survival (RS) and overall survival (OS). PATIENTS AND METHODS This nationwide cohort study included all patients diagnosed with pT1 adenocarcinoma of the colon between 2015-2022, identified from the Netherlands Cancer Registry (NCR). Multilevel, multivariable logistic regression models estimated the probability of undergoing LR per hospital, adjusted for case-mix variables. Hospitals were categorized into low, average, or high attitude towards LR. RS and OS were calculated using multivariable regression analysis. RESULTS A total of 9,650 patients from 73 hospitals were included, with 3,999 (41.4%) receiving PS and 5,651 (58.6%) undergoing LR first. From 2015 to 2022, the national proportion of PS decreased from 53.2% to 29.7%. The RRadj for LR varied across hospitals (RRadj 0.46-1.29). No significant differences in RS or OS were found between high- vs. low attitude centers (5-year RS 99.0% vs. 97.7%, RER 0.97, 95%CI 0.51-1.84 and OS 87.9% vs. 86.4%, HRadj 0.95, 95%CI 0.81-1.11), nor between patients treated after vs. before 2018 (5-year RS 98.7% vs. 98.7%, RER 0.82, 95%CI 0.46-1.46 and OS 86.7% vs. 88.0%, HRadj 0.98, 95%CI 0.85-1.13). CONCLUSIONS While inter-hospital variation exists, LR of T1 CC is increasingly preferred in the Netherlands, leading to a reduction in the number of surgeries without a change in RS or OS.

Publikationsverlauf

Eingereicht: 01. Dezember 2024

Angenommen nach Revision: 27. April 2025

Accepted Manuscript online:
27. April 2025