TY - JOUR
T1 - Resection of Obstructive Left-Sided Colon Cancer at a National Level
T2 - A Prospective Analysis of Short-Term Outcomes in 1,816 Patients
AU - Tanis, Pieter J.
AU - Paulino Pereira, Nuno R.
AU - the Dutch ColoRectal Audit
AU - Van Hooft, Jeanin E.
AU - Consten, Esther C.J.
AU - Bemelman, Willem A.
N1 - Publisher Copyright:
© 2015 S. Karger AG, Basel.
PY - 2015/9
Y1 - 2015/9
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84936951493&partnerID=8YFLogxK
U2 - 10.1159/000433561
DO - 10.1159/000433561
M3 - Article
C2 - 26159388
AN - SCOPUS:84936951493
SN - 0253-4886
VL - 32
SP - 317
EP - 324
JO - Digestive Surgery
JF - Digestive Surgery
IS - 5
ER -
