N. Ullman1, O. Prela1, P. Chung1, M. Smith1, R. Zhu1, H. Talus2, A. Alfonso1, G. Sugiyama1 1SUNY Downstate College Of Medicine,General Surgery,Brooklyn, NY, USA 2Kings County Hospital Center,Surgery,Brooklyn, NY, USA
Introduction:
Colorectal cancer is the second leading cause of cancer related deaths in the US. African Americans have a greater incidence, higher mortality rate and are more likely to present at an advanced stage when compared to their Caucasian counterparts. We explored the difference in African-American and Caribbean born (Afro-Caribbean) patients that underwent surgery for colorectal cancer at two urban safety-net hospitals.
Methods:
We conducted a retrospective chart review of patients that underwent resection for colorectal cancer from 2007-2015. Patients were stratified by race and country of birth; 119 African American and 203 Afro-Caribbean patients were identified. We then compared rates of disease presentation requiring urgent or emergent surgical intervention and rates of presentation allowing for elective procedures. Emergent/urgent presentation was defined as surgical intervention to treat a tumor complication on the same hospital admission in which the diagnosis of colorectal cancer was made. Tumor complication rates between each group were also compared. Complications included obstruction, anemia requiring transfusion, colonic perforation and hemorrhage. Comparisons were performed using the Chi Square Test for emergent/urgent vs elective case presentations and the Fisher's Exact Test for tumor complication rates.
Results:
There was no significant difference in the rate of urgent/emergent cases of colorectal cancer when compared to elective procedures. We identified 30 (25.2%) African American patients compared to 55 (27.1%) Afro-Caribbean patients that required an urgent/emergent procedure (p = 0.7912). African American compared to Afro-Caribbean patients had no statistically significant differences in the rate of obstruction (9.24% vs 9.85%, p = 1.0), hemorrhage (7.56% vs 5.42% p = 0.4778), and perforation (3.36% vs 2.96% p = 1.0). However Afro-Caribbean patients were more likely to present with anemia requiring transfusion (7.88% vs 1.68%, p = 0.0221).
Conclusion:
In this retrospective chart review of colorectal cancer in African American and Afro-Caribbean patients treated at two urban safety-net hospitals, there is little difference in the rates of emergent presentations of disease between the two cohorts. Of the tested disease complications, only one was shown to be significantly different. Despite this singular difference, we postulate that there may be a variance in the disease process found in these cohorts. We suspect that an underlying difference in tumor biology contributes to this discrepancy. A follow up study to examine the pathology of the specimens from each cohort may shed light onto this difference.
