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, five other manuscripts within this Snapshot project have either been accepted for publication or published by JAMA Surgery, Annals of Surgery, Annals of Surgical Oncology, Journal of the National Comprehensive Cancer Network (JNCCN), and International Journal of Colorectal Disease.