Clinical issues in the surgical treatment of colon cancer

More than half of colon cancer patients will eventually die of their disease. Early detection is crucial to maximize chances of cure, as five-year survival can range from 97% to as low as 8% depending on disease stage at diagnosis. Since colon cancer is associated with both old age and obesity, nearly 60% of new cases come from the developed world, where many nationwide screening initiatives have been launched in the last two decades, in an effort to lower incidence rates and to provide early detection. Although successful, screening benefits are offset by an aging and increasingly obese and paradoxically malnourished population, and the fact that lower age thresholds exclude younger patients.
Surgical resection remains the only definitive therapy for colon cancer. Consequently, essentially all curable colon cancer cases will be treated surgically, thereby forming a large, heterogeneous and ever changing population. The clinical issues and challenges faced during the surgical treatment of colon cancer will therefore come in many forms, ranging from patient factors existing long before enrollment in surgical treatment, to factors specific to the surgical admission itself such as perioperative complications or the specifics of surgical pathology.
This dissertation is based around a cohort comprising all 1071 patients treated surgically for colon cancer at Massachusetts General Hospital in the 2004 through 2011 timeframe. Data on these patients was stored in an anonymized database after institutional review board approval, specifically for the purpose of the research topics described in this dissertation.