Resection of Obstructive Left-Sided Colon Cancer at a National Level: A Prospective Analysis of Short-Term Outcomes in 1,816 Patients
- 4 July 2015
- journal article
- research article
- Published by S. Karger AG in Digestive Surgery
- Vol. 32 (5), 317-324
- https://doi.org/10.1159/000433561
Abstract
Background/Aims: The prematurely closed Stent-In II trial in patients with left-sided obstructive colon cancer may have influenced clinical decision making in The Netherlands. The aim of this study was to evaluate treatment of left-sided malignant colon obstruction at a population level since then. Methods: Short-term outcomes of all patients who underwent resection for left-sided obstructive colon cancer between 2009 and 2012 were assessed based on a prospective national registry. Results: In total, 1,816 evaluable patients were included; acute resection was performed in 1,485 (81.8%), and endoscopic stent or decompressing stoma followed by resection in 196 (10.8%) and 135 (7.4%), respectively. The use of endoscopic stenting significantly decreased from 18% (2009) to 6% (2012). Overall 30-day or in-hospital mortality rate was 6.9, 5.6, and 3.7%, respectively (p = 0.107). Mortality rate after acute resection was 2.9% in patients >70 years, but mortality rates up to 32.2% were observed in high-risk elderly patients. Conclusion: Acute resection as first choice treatment seems justified for patients >70 years of age given a mortality rate of 3%. For the elderly frail patients, mortality rates over 30% after acute resection stress the need for alternative treatment strategies.Keywords
This publication has 23 references indexed in Scilit:
- Feasibility of preoperative chemotherapy for locally advanced, operable colon cancer: the pilot phase of a randomised controlled trialThe Lancet Oncology, 2012
- Systematic review and meta-analysis of randomized clinical trials of self-expanding metallic stents as a bridge to surgery versus emergency surgery for malignant left-sided large bowel obstructionBritish Journal of Surgery, 2012
- Endoscopic placement of self-expandable metal stents for malignant colonic obstruction: long-term outcomes and complication factorsGastrointestinal Endoscopy, 2010
- Surgical practices for malignant left colonic obstruction in GermanyEuropean Journal of Surgical Oncology, 2010
- Primary vs . Delayed Resection for Obstructive Left-Sided Colorectal Cancer: Impact of Surgery on Patient OutcomeDiseases of the Colon & Rectum, 2008
- Use of Colonic Stents in Emergent Malignant Left Colonic Obstruction: A Markov Chain Monte Carlo Decision AnalysisDiseases of the Colon & Rectum, 2007
- Comparison of colonic stenting and open surgery for malignant large bowel obstructionSurgical Endoscopy, 2007
- The Association of Coloproctology of Great Britain and Ireland Study of Large Bowel Obstruction Caused by Colorectal CancerAnnals of Surgery, 2004
- Emergency Surgery for Colon CarcinomaDiseases of the Colon & Rectum, 2003
- Malignant obstruction of the left colonBritish Journal of Surgery, 1994