| Summary: | This thesis examines colorectal cancer (CRC) outcomes in England including re-operation, perioperative mortality and survival. The aim of this thesis has been to explore the patient, presentation mode (emergency or elective), tumour biology and healthcare provision factors that contribute to poor outcome (perioperative morbidity and mortality, reduced survival) in CRC patients in England. Several methodologies have been used to answer the relevant scientific questions, including local (hospital) clinical data, screening data, systematic reviews and meta analyses, regional cancer datasets as well as national administrative datasets. This thesis has demonstrated that a variety of socioeconomic, disease and presentation factors contribute to poor outcome including ethnicity (Black Afro-Caribbean patients), social deprivation and patients undergoing emergency resection for their CRC. Similarly, patients with Inflammatory Bowel Disease (IBD) and cancer are more likely to require immediate perioperative re-intervention and re-operation than those without IBD. They also tend to have a worse overall survival. The way healthcare is delivered to patients with CRC can also have an impact on outcomes. Patients selected to undergo laparoscopic resection for CRC had fewer complications, and in the long-term their survival was better than patients undergoing open procedures. The use of new minimal access surgery as well as better care may be the drivers behind improving outcomes in England. There appears to be a wide variation in the patients we offer surgery to. In the elderly group (over 80 years of age), the variability in the percentage of elderly patients undergoing surgery in different units was significant (ranging from 6.2% to 83.3%). To improve outcomes nationally, it is vital that we strengthen targeted measures such as population screening, obtain better control of diseases contributing to CRC (such as IBD) and develop a standardised selection process in choosing the patients that would benefit the most from surgery.
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