International Journal of Colorectal Disease

, Volume 34, Issue 11, pp 1933–1943 | Cite as

Long-term outcome after one-stage surgery without preoperative decompression for stage II/III malignant colorectal obstruction: a propensity score-matched analysis

  • Hiroshi TakeyamaEmail author
  • Kimimasa Ikeda
  • Katsuki Danno
  • Takahiko Nishigaki
  • Masafumi Yamashita
  • Hirokazu Taniguchi
  • Yoshio Oka
Original Article



Whether malignant colorectal obstruction (MCO) after one-stage curative surgery without preoperative decompression has a poor prognosis remains unclear. We assessed long-term outcomes of one-stage surgery without preoperative decompression for stage II/III MCO.


We retrospectively enrolled patients with stage II/III colorectal cancer (CRC) between April 2011 and December 2017. Propensity score-matched (PSM) analysis was used to reduce the possibility of selection bias.


In total, 464 stage II/III CRC patients were identified, of which 145 (31%) had obstruction (MCO group) and 319 (69%) did not (non-MCO group). In the MCO group, 59 (40.7%) had emergency MCO (E-MCO) and 86 (59.3%) had semi-emergency MCO (SE-MCO). The median follow-up was 37.0 (range 0–86.5) months. The tumor was deeper and larger, and serum carcinoembryonic antigen level was higher (p < 0.001, respectively) in the MCO group (including E-MCO and SE-MCO). Venous invasion-positivity rate was significantly higher (MCO and SE-MCO only, p = 0.003 and 0.009, respectively) than that in the non-MCO group. Laparoscopic surgery rate was significantly lower (MCO and E-MCO only, p < 0.001) than that in the non-MCO group. Before PSM, disease-free survival (DFS) of the SE-MCO patients was worse than that of the non-MCO patients (p = 0.046). After PSM, DFS was not significantly different between the non-MCO and MCO, E-MCO, and SE-MCO groups (p = 0.619, 0.091, and 0.308, respectively).


Long-term prognosis in patients with stage II/III MCO after one-stage surgery without preoperative decompression was similar to that in patients without MCO.


One-stage surgery Malignant colorectal obstruction Colorectal cancer Preoperative decompression Emergency 


Compliance with ethical standards

The study protocol was approved by the Institutional Review Board of Minoh City Hospital (IRB No. R01-B4) and was conducted according to the ethical guidelines of the Declaration of Helsinki.

Conflict of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    De Salvo GL, Gava C, Pucciarelli S, Lise M (2004) Curative surgery for obstruction from primary left colorectal carcinoma: primary or staged resection? Cochrane Database Syst Rev 2.
  2. 2.
    Katoh H, Yamashita K, Wang G, Sato T, Nakamura T, Watanabe M (2011) Prognostic significance of preoperative bowel obstruction in stage III colorectal cancer. Ann Surg Oncol 18:2432–2441. CrossRefPubMedGoogle Scholar
  3. 3.
    Okuda Y, Shimura T, Yamada T, Hirata Y, Yamaguchi R, Sakamoto E, Kataoka H (2018) Colorectal obstruction is a potential prognostic factor for stage II colorectal cancer. Int J Clin Oncol 23:1101–1111. CrossRefPubMedGoogle Scholar
  4. 4.
    Mulcahy HE, Skelly MM, Husain A, O’Donoghue DP (1996) Long-term outcome following curative surgery for malignant large bowel obstruction. Br J Surg 83:46–50. CrossRefPubMedGoogle Scholar
  5. 5.
    National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology (NCCN Guidelines) Colon cancer (2017) Version 2. NCCN Web site. Available at:
  6. 6.
    Schmoll HJ, Van Cutsem E, Stein A et al (2012) ESMO consensus guidelines for management of patients with colon and rectal cancer. A personalized approach to clinical decision making. Ann Oncol 23:2479–2516CrossRefGoogle Scholar
  7. 7.
    Artac M, Turhal NS, Kocer M, Karabulut B, Bozcuk H, Yalcin S, Karaagac M, Gündüz S, Isik N, Uygun K (2014) Do high-risk features support the use of adjuvant chemotherapy in stage II colon cancer? A Turkish Oncology Group study. Tumori 100:143–148. CrossRefPubMedGoogle Scholar
  8. 8.
    Benson AB 3rd, Schrag D, Somerfield MR et al (2004) American Society of Clinical Oncology recommendations on adjuvant chemotherapy for stage II colon cancer. J Clin Oncol 22:3408–3419. CrossRefPubMedGoogle Scholar
  9. 9.
    Kumar A, Kennecke HF, Renouf DJ, Lim HJ, Gill S, Woods R, Speers C, Cheung WY (2015) Adjuvant chemotherapy use and outcomes of patients with high-risk versus low-risk stage II colon cancer. Cancer 121:527–534. CrossRefPubMedGoogle Scholar
  10. 10.
    Park JS, Chon HJ, Jeung HC, Shin SJ, Rha SY, Ahn JB, Lee KY, Kim NK, Chung HC (2016) High-risk clinicopathological features and their predictive significance in Korean patients with stage II colon cancer. J Cancer Res Clin Oncol 142:2051–2059. CrossRefPubMedGoogle Scholar
  11. 11.
    Biondo S, Pares D, Frago R, Martí-Ragué J, Kreisler E, De Oca J, Jaurrieta E (2004) Large bowel obstruction: predictive factors for postoperative mortality. Dis Colon Rectum 47:1889–1897. CrossRefPubMedGoogle Scholar
  12. 12.
    Smothers L, Hynan L, Fleming J, Turnage R, Simmang C, Anthony T (2003) Emergency surgery for colon carcinoma. Dis Colon Rectum 46:24–30. CrossRefPubMedGoogle Scholar
  13. 13.
    Baccari P, Bisagni P, Crippa S, Sampietro R, Staudacher C (2006) Operative and long-term results after one-stage surgery for obstructing colonic cancer. Hepatogastroenterology 53:698–701PubMedGoogle Scholar
  14. 14.
    Morita S, Ikeda K, Komori T, Tanida T, Hatano H, Tomimaru Y, Imamura H, Dono K (2016) Outcomes in colorectal surgeon-driven management of obstructing colorectal cancers. Dis Colon Rectum 59:1028–1033. CrossRefPubMedGoogle Scholar
  15. 15.
    Otsuka S, Kaneoka Y, Maeda A, Takayama Y, Fukami Y, Isogai M (2015) One-stage colectomy with intraoperative colonic irrigation for acute left-sided malignant colonic obstruction. World J Surg 39:2336–2342. CrossRefPubMedGoogle Scholar
  16. 16.
    Carraro PG, Segala M, Cesana BM, Tiberio G (2001) Obstructing colonic cancer: failure and survival patterns over a ten-year follow-up after one-stage curative surgery. Dis Colon Rectum 44:243–250. CrossRefPubMedGoogle Scholar
  17. 17.
    Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, Poole C, Schlesselman JJ, Egger M, STROBE Initiative (2007) Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Epidemiology 18:805–835. CrossRefPubMedGoogle Scholar
  18. 18.
    van Hooft JE, Bemelman WA, Oldenburg B, Marinelli AW, Lutke Holzik MF, Grubben MJ, Sprangers MA, Dijkgraaf MG, Fockens P, collaborative Dutch Stent-In Study Group (2011) Colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a multicentre randomised trial. Lancet Oncol 12:344–352. CrossRefPubMedGoogle Scholar
  19. 19.
    Matsuzawa T, Ishida H, Yoshida S, Isayama H, Kuwai T, Maetani I, Shimada M, Yamada T, Saito S, Tomita M, Koizumi K, Hirata N, Sasaki T, Enomoto T, Saida Y (2015) A Japanese prospective multicenter study of self-expandable metal stent placement for malignant colorectal obstruction: short-term safety and efficacy within 7 days of stent procedure in 513 cases. Gastrointest Endosc 82:697–707. CrossRefPubMedGoogle Scholar
  20. 20.
    Watanabe T, Muro K, Ajioka Y et al (2018) Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer. Int J Clin Oncol 23:1–34. CrossRefPubMedGoogle Scholar
  21. 21.
    Jiang JK, Lan YT, Lin TC, Chen WS, Yang SH, Wang HS, Chang SC, Lin JK (2008) Primary vs. delayed resection for obstructive left-sided colorectal cancer: impact of surgery on patient outcome. Dis Colon Rectum 51:306–311. CrossRefPubMedGoogle Scholar
  22. 22.
    Awotar GK, Guan G, Sun W et al (2017) Reviewing the management of obstructive left colon cancer: assessing the feasibility of the one-stage resection and anastomosis after intraoperative colonic irrigation. Clin Colorectal Cancer 16:e89–e103. CrossRefPubMedGoogle Scholar
  23. 23.
    Kronborg O (1995) Acute obstruction from tumour in the left colon without spread. A randomized trial of emergency colostomy versus resection. Int J Colorectal Dis 10:1–5CrossRefGoogle Scholar
  24. 24.
    Lacy AM, García-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229. CrossRefPubMedGoogle Scholar
  25. 25.
    Lim TZ, Chan DKH, Tan KK (2017) Endoscopic stenting does not worsen long term outcomes amongst patients presenting with obstruction from colorectal cancers. Ann Surg Oncol 24:1618–1625. CrossRefPubMedGoogle Scholar
  26. 26.
    Takeyama H, Kitani K, Wakasa T, Tsujie M, Fujiwara Y, Mizuno S, Yukawa M, Ohta Y, Inoue M (2016) Self-expanding metallic stent improves histopathologic edema compared with transanal drainage tube for malignant colorectal obstruction. Dig Endosc 28:456–464. CrossRefPubMedGoogle Scholar
  27. 27.
    van Hooft JE, van Halsema EE, Vanbiervliet G et al (2014) Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Gastrointest Endosc 46:990–1053. CrossRefGoogle Scholar
  28. 28.
    Takahashi G, Yamada T, Iwai T, Takeda K, Koizumi M, Shinji S, Uchida E (2018) Oncological assessment of stent placement for obstructive colorectal cancer from circulating cell-free DNA and circulating tumor DNA dynamics. Ann Surg Oncol 25:737–744. CrossRefPubMedGoogle Scholar
  29. 29.
    Sloothaak DA, van den Berg MW, Dijkgraaf MG, Fockens P, Tanis PJ, van Hooft JE, Bemelman WA, collaborative Dutch Stent-In study group (2014) Oncological outcome of malignant colonic obstruction in the Dutch Stent-In 2 trial. Br J Surg 101:1751–1757. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Gastroenterological SurgeryMinoh City HospitalOsakaJapan

Personalised recommendations