A comparison of the management and outcomes of colorectal cancer in Denmark and the Yorkshire region of the United Kingdom

Survival differences for patients with colorectal cancer have caused considerable concern in Denmark and the UK where rates have compared unfavourably with many other countries with similar health systems. Interventions in Denmark have included detailed reviews of observational data to quantify patterns of practice and identify areas of concern. There is strong evidence this has radically changed practice and improved patient outcomes. The aim of the research described in this thesis was to identify differences in the surgical management of patients with colorectal cancer between Denmark and a representative region of the UK (Yorkshire).

Data from the cancer registry in England and clinical data from Denmark were collated to compare surgical treatment and outcomes for patients with colorectal cancer in Yorkshire and Denmark. Three aspects of surgical treatment were identified for comparison, these were the use of: major surgical resection, emergency surgery and minimally invasive surgery (MIS).

The use of major surgical resection was higher in Denmark than Yorkshire, especially in more elderly patients, corresponding to an increased postoperative 30-day mortality, but higher 1-year overall survival from diagnosis. A larger decrease in overall postoperative mortality in Denmark has coincided with a reduction in the use of emergency resection and an increase in stenting procedures. Uptake of MIS in patients undergoing elective surgery for colorectal cancer in Yorkshire was slower than in Denmark, for both laparoscopic and robotic procedures.

This study’s data-driven approach identified several differences in the surgical management of patients with colorectal cancer between Yorkshire and Denmark. Teams managing elderly patients should balance the short-term risk versus the long-term benefit of major surgery. Consensus guidelines for converting potential emergency resections into elective resections may help lower rates of emergency surgery in Yorkshire. Ensuring adequate training and access to laparoscopic equipment should increase use of MIS in Yorkshire.