lncidence of Colorectal Cancer and Comparisons of Outcomes after Minimally Invasive and Open Surgery

Abstract: Aim: Surgery remains the mainstay of treatment for colorectal cancer. The aim of this thesis was to determine the overall incidence of colorectal cancer in Sweden over time and to evaluate surgical treatment comparing minimally invasive surgery including laparoscopic and robot assisted laparoscopic surgery to open surgery. Methods: Paper I explores the overall incidence of colorectal cancer in Sweden over time. Papers II-IV report results from two population based cohort studies and a randomized controlled trial. The papers compare minimally invasive surgery including laparoscopic and robot assisted laparoscopic surgery to open surgery for colon and rectal cancer. Results: Paper I found a decrease in the overall incidence of colorectal cancer in Sweden in the last decade, whilst the incidence in patients under the age of 50 years continued to increase. Paper II demonstrated favorable short-term outcomes following laparoscopic surgery compared to open surgery for colon cancer. Paper III showed that minimally invasive surgery for rectal cancer was non-inferior to open surgery with regard to adequate cancer resection with advantageous short-term outcomes. There were no long-term difference in risk of bowel obstruction, incisional, or parastomal hernia comparing the surgical techniques in patients with rectal cancer as reported in paper IV. Conclusion: The overall incidence of colorectal cancer in Sweden has decreased in the last decade, despite an increase in the younger population. Surgical resection for colorectal cancer using minimally invasive technique is oncologically safe with favorable short-term outcomes compared to open surgery. No advantage was found following minimally invasive surgery for rectal cancer with regard to long-term risk of bowel obstruction, incisional and parastomal hernia.