obstructive colon cancer
– The third Dutch Snapshot study –
Acute bowel obstruction occurs in 8-13% of patients with colon cancer.1 Many of the patients with acute left-sided obstructive colon cancer are elderly and in a poor clinical condition, in whom emergency resection has shown high mortality and morbidity.2 Consequently, the revised national and European guidelines (2014) recommended bridge to surgery (BTS) with either self-expandable metal stent (SEMS) or decompressing stoma (DS) in these high-risk patients. However, oncological safety are the main hurdle for routine implementation, although long-term results are still scarce.3 Furthermore, few studies exist on decompressing stoma as BTS and the use of this approach is still restricted.
1) To perform an in-depth update of national practice concerning curative treatment of acute left-sided obstructive colon cancer, including an evaluation of guideline implementation;
2) To assess the long-term oncological outcomes of SEMS as BTS.
A retrospective, collaborative research project was conducted in the Netherlands by the DSRG according to a methodology as described previously. Thirty-day data were retrieved from the DCRA, a prospective (mandatory) national registry of patients operated for colorectal cancer. During a period of three months, this database was extended by surgical residents under supervision of a consultant surgeon with additional diagnostic and procedural data as well as long-term outcomes using a secured web-based tool.
All patients who had a resection of left-sided obstructive colon cancer between January 2009 and December 2016. Patients with an extracolonic malignancy and/or signs of bowel perforation on CT were excluded.
The first publication within this Snapshot project revealed that stent placement as a bridge to elective resection seems an oncologically safe alternative to emergency resection, with a three-year locoregional recurrence rate of 11.4% versus 13.6% (p=0.457), a disease-free survival rate of 58.8% versus 52.6% (p=0.175), and an overall survival rate of 74.0% versus 68.3% (p=0.231), respectively. Patients who had a stent placed had a lower permanent stoma rate than emergency resection patients (23.9% versus 45.3%, p<0.001), especially in elderly patients (29.0% versus 57.9%, p<0.001).
Currently, one other article within this Snapshot project on changes in treatment of left-sided obstructive colon cancer over time has been accepted for publication by the Journal of the National Comprehensive Cancer Network (JNCCN).