eP573 - Characterizing Patients Undergoing Oncologic Colorectal Resection Under the Age of 45

Purpose/Background: In 2021, the US Preventive Services Task Force issued a recommendation to change the colorectal cancer screening age from 50 to 45 based on the trend of growing cases among younger adults after a recommendation from the American Cancer Society in 2018. Increasingly, younger patients are undergoing colorectal resection. The aim of this study is to characterize the demographics and outcomes of patients under the age of 45 who are undergoing colorectal resection.Methods/Interventions: A retrospective cohort study of single-institution ACS-NSQIP data 2018-2023 was conducted on patients who underwent colorectal cancer surgery, categorized into two age groups: >45 years and < 45 years. Data encompassed patient factors (age, sex, race, BMI, payor information, ASA), disease factors (cancer stage, tumor type), and surgical factors (laparoscopic or open, elective or emergent, ostomy creation). Primary outcome was characterizing patient and disease factors for those who were < 45 at the time of resection. Secondary outcomes were post-operative outcomes, including 30-day readmissions and post-operative length of stay. A sub-analysis of patients with rectal cancer was performed. Statistical analyses included bivariate analysis in R.Results/Outcomes: Overall, there were 846 patients who underwent surgery for colorectal cancer during this time, with 757 greater than 45 years of age and 89 below the age of 45. The younger cohort had a higher proportion of males (64.0% vs. 50.6%, p=0.022), higher mean BMI (31.1 vs. 28.9, p=0.00527), had a lower proportion of patients ASA 3 patients (74.2% vs 83.1%, p < 0.001), and were more often privately insured (62.9% vs 33.9%, p < 0.001). Overall, patients predominantly underwent laparoscopic approach (70.8% vs. 69.2%, p=0.856). Tumor types and stages showed variations, with a higher prevalence of rectal cancer (32.6% vs. 21.7%, p=0.0286) and a trend towards more advanced stages (15.7% Stage IV vs 9.0%, p=0.05). Postoperative length of stay did not differ significantly between the age groups (4.89 vs. 5.33, p=0.367). The younger cohort had a higher rate of 30-day readmissions (18.0% vs. 10.7%, p=0.0416), likely due to the higher rate of rectal cancer. Among patients with rectal cancer (n=195), younger patients were more likely to be black than those undergoing oncologic resection over the age of 45 (41.4% vs 19.9%, p=0.03)Conclusion/

Discussion: Patients undergoing colorectal cancer surgery under the age of 45 years are more likely to present with rectal cancer, later stage cancer, and have higher rates of readmissions. They are more often male, have a higher ASA score, and have higher BMI. Notably, among patients with rectal cancer, patients under 45 requiring oncologic resection were more likely to be Black. While recent changes in screening guidelines have helped capture the increasingly young population of colorectal cancer patients, for some, screening may need to begin even sooner.