Long-term outcome after one-stage surgery without preoperative decompression for stage II/III malignant colorectal obstruction: a propensity score-matched analysis
- 16 Downloads
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.
KeywordsOne-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.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. https://doi.org/10.1002/14651858.CD002101.pub2
- 5.National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology (NCCN Guidelines) Colon cancer (2017) Version 2. NCCN Web site. Available at: http://www.nccn.org/professionals/
- 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. https://doi.org/10.1177/030089161410000205 CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1007/s00432-016-2208-2 CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1097/ede.0b013e3181577511 CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1016/s1470-2045(11)70035-3 CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1016/j.gie.2015.03.1978 CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1016/j.clcc.2016.12.001 CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1016/s0140-6736(02)09290-5 CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1111/den.12585 CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1055/s-0034-1390700 CrossRefGoogle Scholar
- 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. https://doi.org/10.1245/s10434-017-6300-x CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1002/bjs.9645 CrossRefPubMedPubMedCentralGoogle Scholar