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Oh SY, Kim CW, Kim S, Kim MH, Kim YI, Lee JL, Yoon YS, Park IJ, Lim SB, Yu CS. Complete Obstruction, a Real Risk Factor: A Comprehensive Study on Obstruction in Stage IIA Colon Cancer With Propensity Score Matching Analysis. Clin Colorectal Cancer 2024; 23:135-146.e3. [PMID: 38749791 DOI: 10.1016/j.clcc.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/03/2024] [Accepted: 04/06/2024] [Indexed: 06/04/2024]
Abstract
MICROABSTRACT This study evaluates the prognostic significance of obstructions in stage IIA colon cancer, distinguishing between partial and complete obstructions. It employs a retrospective review of 1914 patients with propensity score matching to analyze oncologic outcomes. Findings reveal complete obstruction as a significant risk factor for poorer outcomes, emphasizing the necessity for further research to refine treatment strategies, particularly regarding the efficacy of adjuvant chemotherapy across obstruction types. BACKGROUND This study examined the prognostic impact of obstructions in stage IIA colon cancer. The analysis specifically differentiated partial and complete obstructions, analyzing their distinct influences of both on oncologic outcomes. MATERIALS AND METHODS A retrospective review was conducted of stage IIA colon cancer cases with the presence of an obstruction. Patients were stratified by whether it was partial or complete based on the severity of obstruction. Propensity score matching was employed to control for confounders. RESULTS Among 1914 consecutive patients diagnosed with stage IIA colon cancer, 758 patients (597 patients with partial obstruction, 161 patients with complete obstruction) exhibited obstruction, while 1156 patients had no obstruction. The median follow-up period was 126 months. Complete obstruction was associated with poorer disease-free survival (Hazard ratio (HR) = 1.785, P < .001) and overall survival (HR = 1.853, P = .001). This trend persisted after propensity score matching, patients with complete obstruction showing a worsened disease-free survival (HR = 1.666, P = .028) and overall survival (HR = 1.732, P = .041). Adjuvant chemotherapy showed improved outcomes overall, but its efficacy varied across obstruction types. CONCLUSION Differentiating between complete and partial obstructions in stage IIA colon cancer is an important clinical distinction, as our findings suggest that complete obstruction is a significant risk factor for poorer oncologic outcomes. While adjuvant chemotherapy generally improves prognosis in stage IIA colon cancer, the correlation of obstruction type with its efficacy remains uncertain, necessitating further research to refine treatment strategies.
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Affiliation(s)
- Soo Young Oh
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea; Department of Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chan Wook Kim
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea.
| | - Seonok Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Republic of Korea
| | - Min Hyun Kim
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Young Il Kim
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Jong Lyul Lee
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Yong Sik Yoon
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - In Ja Park
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Seok-Byung Lim
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Chang Sik Yu
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
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Yu W, Zhang Q, Ali M, Chen B, Yang Y, Wang L, Sun Q, Wang Y, Wang D. A nomogram for predicting the recurrence of small bowel obstruction after gastrectomy in patients with gastric cancer. World J Surg Oncol 2023; 21:351. [PMID: 37946228 PMCID: PMC10633924 DOI: 10.1186/s12957-023-03197-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/19/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND This study aimed to create a nomogram for predicting the recurrence of small bowel obstruction (SBO) after gastrectomy in patients with gastric cancer (GC) in order to provide better guidance for its diagnosis and treatment. METHODS A total of 173 patients undergone gastrectomy and developed SBO from January 2015 to October 2022 were admitted into this case-control study. The risk factors of postoperative recurrent SBO were analyzed by univariate and multivariate regression, and a nomogram for predicting the recurrent SBO after gastrectomy was developed using R Studio. RESULTS Thirty-nine cases of postoperative recurrent SBO occurred among the 173 GC patients who underwent radical gastrectomy, and the percentage of recurrent SBO was 22.54% (39/173). Age [odds ratio (OR) = 0.938, p = 0.026], WBC count (OR = 1.547, p < 0.001), tumor size (OR = 1.383, p = 0.024), postoperative metastasis (OR = 11.792, p = 0.030), and the interval from gastrectomy to first SBO (OR = 1.057, p < 0.001) were all identified as independent risk factors for postoperative recurrent SBO by logistic regression analysis. The receiver operating characteristic curve, the calibration curve, the model consistency index, and the decision curve analysis showed that the nomogram had good predictive performance. CONCLUSION Based on these factors, we created a nomogram to predict the occurrence of postoperative recurrent SBO. This novel nomogram could serve as a crucial early warning indicator that would guide doctors to make informed decisions while managing patients with gastric cancer.
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Grants
- No. 81972269 the National Natural Science Foundation of China
- No. 81972269 the National Natural Science Foundation of China
- No. 81972269 the National Natural Science Foundation of China
- No. 81972269 the National Natural Science Foundation of China
- No. 81972269 the National Natural Science Foundation of China
- No. 81972269 the National Natural Science Foundation of China
- No. 81972269 the National Natural Science Foundation of China
- No. 81972269 the National Natural Science Foundation of China
- No. 81972269 the National Natural Science Foundation of China
- No. YZ2020159 Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
- No. YZ2020159 Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
- No. YZ2020159 Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
- No. YZ2020159 Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
- No. YZ2020159 Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
- No. YZ2020159 Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
- No. YZ2020159 Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
- No. YZ2020159 Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
- No. YZ2020159 Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
- No. Bk20221144 the Natural Science Foundation of Jiangsu Province
- No. Bk20221144 the Natural Science Foundation of Jiangsu Province
- No. Bk20221144 the Natural Science Foundation of Jiangsu Province
- No. Bk20221144 the Natural Science Foundation of Jiangsu Province
- No. Bk20221144 the Natural Science Foundation of Jiangsu Province
- No. Bk20221144 the Natural Science Foundation of Jiangsu Province
- No. Bk20221144 the Natural Science Foundation of Jiangsu Province
- No. Bk20221144 the Natural Science Foundation of Jiangsu Province
- No. Bk20221144 the Natural Science Foundation of Jiangsu Province
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Affiliation(s)
- Wenhao Yu
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, Jiangsu Province, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Medical College of Yangzhou University, Yangzhou, China
| | - Qi Zhang
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, Jiangsu Province, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Medical College of Yangzhou University, Yangzhou, China
| | - Muhammad Ali
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, Jiangsu Province, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Medical College of Yangzhou University, Yangzhou, China
| | - Bangquan Chen
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, Jiangsu Province, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Medical College of Yangzhou University, Yangzhou, China
| | - Yapeng Yang
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, Jiangsu Province, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Medical College of Yangzhou University, Yangzhou, China
| | - Liuhua Wang
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, Jiangsu Province, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
| | - Qiannan Sun
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, Jiangsu Province, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
| | - Yong Wang
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, Jiangsu Province, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
| | - Daorong Wang
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, Jiangsu Province, China.
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China.
- Medical College of Yangzhou University, Yangzhou, China.
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Adams K, Chapuis PH, Keshava A, Rickard MJFX, Stewart P, Suen M, Chan C, Dent OF. Recurrence and colon cancer-specific death in patients with large bowel obstruction requiring urgent operation: a competing risks analysis. Colorectal Dis 2021; 23:2604-2618. [PMID: 34252253 DOI: 10.1111/codi.15807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/19/2021] [Accepted: 07/06/2021] [Indexed: 02/08/2023]
Abstract
AIM Clinical presentation with large bowel obstruction has been proposed as a predictor of poor long-term oncological outcomes after resection for colorectal cancer. This study examines the association between obstruction and recurrence and cancer-specific death after resection for colon cancer. METHOD Consecutive patients who underwent resection for colon cancer between 1995 and 2014 were drawn from a prospectively recorded hospital database with all surviving patients followed for at least 5 years. The outcomes of tumour recurrence and colon cancer-specific death were assessed by competing risks multivariable techniques with adjustment for potential clinical and pathological confounding variables. RESULTS Recurrence occurred in 271 of 1485 patients who had a potentially curative resection. In bivariate analysis, obstruction was significantly associated with recurrence [hazard ratio (HR) 2.23, CI 1.52-3.26, p < 0.001] but this association became nonsignificant after adjustment for confounders (HR 1.53, CI 0.95-2.46, p = 0.080). Colon cancer-specific death occurred in 238 of 295 patients who had a noncurative resection. Obstruction was not significantly associated with cancer-specific death (HR 1.02, CI 0.72-1.45, p = 0.903). In patients who had a noncurative resection, the competing risks incidence of colon cancer-specific death was not significantly greater in obstructed than in unobstructed patients (HR 1.02, CI 0.72-1.45, p = 0.903). CONCLUSION Whilst the immediate clinical challenge of an individual patient presenting with large bowel obstruction must be addressed by the surgeon, the patient's long-term oncological outcomes are unrelated to obstruction per se.
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Affiliation(s)
- Katie Adams
- Colorectal Surgical Unit, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Pierre H Chapuis
- Colorectal Surgical Unit, Concord Repatriation General Hospital, Sydney, NSW, Australia.,Department of Surgery, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Anil Keshava
- Colorectal Surgical Unit, Concord Repatriation General Hospital, Sydney, NSW, Australia.,Department of Surgery, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Matthew J F X Rickard
- Colorectal Surgical Unit, Concord Repatriation General Hospital, Sydney, NSW, Australia.,Department of Surgery, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Peter Stewart
- Colorectal Surgical Unit, Concord Repatriation General Hospital, Sydney, NSW, Australia.,Department of Surgery, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Michael Suen
- Colorectal Surgical Unit, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Charles Chan
- Division of Anatomical Pathology, Concord Repatriation General Hospital, Sydney, NSW, Australia.,Department of Pathology, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Owen F Dent
- Colorectal Surgical Unit, Concord Repatriation General Hospital, Sydney, NSW, Australia.,Department of Surgery, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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Ceresoli M, Allievi N, Coccolini F, Montori G, Fugazzola P, Pisano M, Sartelli M, Catena F, Ansaloni L. Long-term oncologic outcomes of stent as a bridge to surgery versus emergency surgery in malignant left side colonic obstructions: a meta-analysis. J Gastrointest Oncol 2017; 8:867-876. [PMID: 29184691 DOI: 10.21037/jgo.2017.09.04] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background The placement of a metallic stent as a bridge to surgery (SBTS) could represents an option for the treatment of left-sided malignant colonic obstruction in centres with adequate skills. Several meta-analyses demonstrated better short-term outcomes after SBTS when compared with emergency surgery (ES); however, some studies reported a higher local recurrence rate. The aim of the present review is to investigate the long-term outcomes of stent bridge to surgery as compared to ES. Methods A systematic review was performed to retrieve studies comparing long-term oncologic outcomes of SBTS and ES. Local and overall recurrence rate, overall and disease-free survival were retrieved and results were expressed as risk ratios. Results Seventeen studies and a total of 1,333 patients were included in the analysis. No significant differences were reported in recurrence rate [risk ratio (RR) =1.11; 95% confidence interval (95% CI): 0.84-1.47, P=0.47], 3-year mortality (RR =0.90; 95% CI: 0.73-1.12, P=0.34) and 5-year mortality (RR =1.00; 95% CI: 0.82-1.22, P=0.99). There were no differences among randomized and observational studies. Conclusions SBTS has similar long-term oncologic outcomes to ES and in centres with appropriate skill should be considered the best treatment option for left-sided malignant colonic obstructions.
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Affiliation(s)
- Marco Ceresoli
- General and Emergency Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Niccolò Allievi
- General and Emergency Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Federico Coccolini
- General and Emergency Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Giulia Montori
- General and Emergency Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Paola Fugazzola
- General and Emergency Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Michele Pisano
- General and Emergency Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Massimo Sartelli
- General and Emergency Surgery Department, Macerata Hospital, Macerata, Italy
| | - Fausto Catena
- Emergency Surgery Department, Parma Hospital, Parma, Italy
| | - Luca Ansaloni
- General and Emergency Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
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5
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Do Types of Perforation Impact Outcomes in Perforated Stage II/III Colorectal Cancer Patients? Int Surg 2017. [DOI: 10.9738/intsurg-d-16-00180.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The purpose of this paper is to compare the oncologic outcomes between colorectal cancer (CRC) patients with tumor perforation and those with perforation proximal to the tumor. Medical charts of 39 patients who underwent emergency surgery for colonic perforation related to potentially curable CRC were reviewed. Eighteen patients developed tumor perforation (group A), whereas 21 patients developed perforation proximal to the tumor (group B). Twenty-four patients were pathologic stage II and 15 patients were stage III. There were no significant differences in the clinicopathologic and surgical data, including hospital mortality, between the groups; however, the incidence of diffuse peritonitis was higher in group B than that in group A (P < 0.01). The induction rates of adjuvant chemotherapy for survivors were identical between the 2 groups. Disease-free and overall survival periods did not significantly differ between the groups. Perforation type was not found to be associated with oncologic outcomes in patients with CRC-related perforation.
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Suárez J, Jimenez-Pérez J. Long-term outcomes after stenting as a “bridge to surgery” for the management of acute obstruction secondary to colorectal cancer. World J Gastrointest Oncol 2016; 8:105-112. [PMID: 26798441 PMCID: PMC4714139 DOI: 10.4251/wjgo.v8.i1.105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 11/04/2015] [Indexed: 02/05/2023] Open
Abstract
Obstructive symptoms are present in 8% of cases at the time of initial diagnosis in cases of colorectal cancer. Emergency surgery has been classically considered the treatment of choice in these patients. However, in the majority of studies, emergency colorectal surgery is burdened with higher morbidity and mortality rates than elective surgery, and many patients require temporal colostomy which deteriorates their quality of life and becomes permanent in 10%-40% of cases. The aim of stenting by-pass to surgery is to transform emergency surgery into elective surgery in order to improve surgical results, obtain an accurate tumoral staging and detection of synchronous lesions, stabilization of comorbidities and performance of laparoscopic surgery. Immediate results were more favourable in patients who were stented concerning primary anastomosis, permanent stoma, wound infection and overall morbidity, having the higher surgical risk patients the greater benefit. However, some findings laid out the possible implication of stenting in long-term results of oncologic treatment. Perforation after stenting is related to tumoral recurrence. In studies with perforation rates above 8%, higher recurrences rates in young patients and lower disease free survival have been shown. On the other hand, after stenting the number of removed lymph nodes in the surgical specimen is larger, patients can receive adjuvant chemotherapy earlier and in a greater percentage and the number of patients who can be surgically treated with laparoscopic surgery is larger. Finally, there are no consistent studies able to demonstrate that one strategy is superior to the other in terms of oncologic benefits. At present, it would seem wise to assume a higher initial complication rate in young patients without relevant comorbidities and to accept the risk of local recurrence in old patients (> 70 years) or with high surgical risk (ASA III/IV).
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Matsuda A, Miyashita M, Matsumoto S, Matsutani T, Sakurazawa N, Takahashi G, Kishi T, Uchida E. Comparison of long-term outcomes of colonic stent as "bridge to surgery" and emergency surgery for malignant large-bowel obstruction: a meta-analysis. Ann Surg Oncol 2014; 22:497-504. [PMID: 25120255 DOI: 10.1245/s10434-014-3997-7] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND The short-term safety and efficacy of insertion of a self-expandable metallic colonic stent followed by elective surgery, bridge to surgery (BTS), for malignant large-bowel obstruction (MLBO) have been well described. However, long-term oncological outcomes are still debated. Hence, this study is conducted to evaluate long-term outcomes of colonic stent insertion followed by surgery for MLBO. METHODS A comprehensive electronic literature search through May 2014 was performed to identify studies comparing long-term outcomes between BTS and emergency surgery for MLBO. The main outcome measures were overall survival (OS), disease-free survival (DFS), and recurrence. A meta-analysis was performed using random-effects models to calculate risk ratios (RRs) with 95 % confidence intervals (95 % CIs). RESULTS There were 11 studies that matched the criteria for inclusion, yielding a total of 1136 patients, of whom 432 (38.0 %) underwent BTS and 704 (62.0 %) underwent emergency surgery. In OS analyses of all patients and patients who underwent curative resection, BTS was similar to emergency surgery [(RR = 0.95; 95 % CI 0.75-1.21; P = 0.66) (RR = 0.96; 95 % CI 0.67-1.37; P = 0.82), respectively]. DFS (RR = 1.06; 95 % CI 0.91-1.24; P = 0.43) and recurrence (RR = 1.13; 95 % CI 0.82-1.54; P = 0.46) did not differ significantly between the BTS and emergency surgery groups. CONCLUSIONS Results of this meta-analysis on long-term as well as well-described short-term outcomes suggest that BTS could be a promising alternative strategy for MLBO patients.
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Affiliation(s)
- Akihisa Matsuda
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan,
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8
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Lee GY, Lee SM, Jang JH, Oh HK, Kim DW, Ahn S, Kang SB. Preoperative constipation is associated with poor prognosis of rectal cancer: a prospective cohort study. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2013; 85:35-42. [PMID: 23833759 PMCID: PMC3699686 DOI: 10.4174/jkss.2013.85.1.35] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 05/02/2013] [Accepted: 05/08/2013] [Indexed: 02/06/2023]
Abstract
Purpose It is unknown whether patients with advanced rectal cancer develop severe constipation. Therefore, the objective of this study was to assess whether constipation severity is associated with pathologic progression of rectal cancer. Methods We analyzed 472 patients with rectal cancer who underwent elective surgical resection between January 2005 and December 2010. Constipation severity was prospectively evaluated in 407 patients (86.2%) using the Cleveland Clinic Constipation Score System. Linear regression analysis was performed to identify clinicopathologic variables associated with constipation. Kaplan-Meier analysis and Cox proportional hazard models were used to evaluate the prognostic value of constipation severity on disease-free and overall survival. Results Multivariable analysis showed that sex (regression coefficient [B] = 1.55; 95% confidence interval [CI], 0.79 to 2.60; P < 0.001), body mass index (B = -0.95; 95% CI, -1.83 to -0.64; P = 0.036), tumor size (B = 1.04; 95% CI, 0.20 to 1.88; P = 0.016), T stage (B = 0.75; 95% CI, 0.23 to 1.27; P = 0.005), and distant metastasis (B = 1.16; 95% CI, 0.03 to 2.30; P = 0.045) were associated with constipation severity. Severe constipation (score ≥ 8) was independently associated with 3-year disease-free survival (vs. scores of 0-3; hazard ratio [HR], 2.39; 95% CI, 1.15 to 4.98; P = 0.020) and 5-year overall survival (HR, 2.30; 95% CI, 1.23 to 4.30; P = 0.009) in multivariable analysis. Conclusion Our results suggest that preoperative constipation severity is associated with advanced pathologic stage and poor oncologic outcomes in patients with rectal cancer.
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Affiliation(s)
- Gil-Yong Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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9
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Honoré C, Goéré D, Souadka A, Dumont F, Elias D. Definition of Patients Presenting a High Risk of Developing Peritoneal Carcinomatosis After Curative Surgery for Colorectal Cancer: A Systematic Review. Ann Surg Oncol 2012; 20:183-92. [DOI: 10.1245/s10434-012-2473-5] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Indexed: 12/17/2022]
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Yamaguchi T, Taniguchi H, Fujita S, Sekine S, Yamamoto S, Akasu T, Kushima R, Tani T, Moriya Y, Shimoda T. Clinicopathological characteristics and prognostic factors of advanced colorectal mucinous adenocarcinoma. Histopathology 2012; 61:162-9. [PMID: 22448644 DOI: 10.1111/j.1365-2559.2012.04235.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIMS Mucinous adenocarcinoma (MUC) is a histological variant of colorectal adenocarcinoma. The aim of the present study was to characterize clinicopathological features and identify prognostic factors of MUCs. METHODS AND RESULTS A total of 181 patients with MUC who underwent surgery between 1975 and 2003 were reviewed. The clinicopathological features of these patients were compared with those of 4125 non-MUC patients. Univariate and multivariate analyses were conducted to identify significant prognostic factors in 102 patients with pT3 or pT4 tumour who underwent curative surgery. Patients with MUCs tended to present with more advanced clinical stages. The overall 5-year survival rate of MUC patients was lower than that of non-MUC patients; however, no prognostic difference was found when patients with the same clinical stages were compared. Multivariate analysis revealed male sex, bowel obstruction and infiltrating growth type as independent prognostic factors. Five-year cancer-specific survival rates for MUC patients with ≤1, 2 and 3 risk factors identified by multivariate analysis were 95.5%, 52.1% and 0.0%, respectively (P < 0.001). CONCLUSIONS Mucinous adenocarcinoma represents a distinct clinicopathological entity. Sex, bowel obstruction and growth patterns might be useful prognostic factors to identify patients with a high risk of recurrence after curative resection of advanced MUCs.
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Affiliation(s)
- Tomohiro Yamaguchi
- Clinical Laboratory Division, National Cancer Center Hospital, Tokyo, Japan
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Abstract
Peritoneal carcinomatosis occurs in patients with advanced gastrointestinal and gynecological malignancies and also in patients who experience recurrence after treatment failure of the primary tumor. Malignant disease in the peritoneal cavity is a morbid and significant predictor of a diminished survival in a cancer patient. Systemic chemotherapy alone will not be adequate to palliate or treat patients with peritoneal carcinomatosis. Cytoreductive surgery is a new surgical technique that is performed using peritonectomy procedures to allow total eradication of peritoneal tumors. Intraperitoneal chemotherapy regimens such as intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) and early postoperative intraperitoneal chemotherapy (EPIC) are effective adjuvant treatment to treat the minimal residual disease after cytoreductive surgery to reduce the risk of locoregional recurrence. A substantial body of evidence available in the current literature has documented the survival benefits of combining cytoreductive surgery and intraperitoneal chemotherapy to treat a previously fatal phase of malignancy. This review provides a summary of the developments in the understanding and treatment of peritoneal surface malignancy from colorectal cancer.
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Affiliation(s)
- Terence C Chua
- UNSW Department of Surgery, Hepatobiliary and Surgical Oncology Unit, St George Hospital, Sydney, Australia
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12
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Alcántara M, Serra-Aracil X, Falcó J, Mora L, Bombardó J, Navarro S. Prospective, controlled, randomized study of intraoperative colonic lavage versus stent placement in obstructive left-sided colonic cancer. World J Surg 2011. [PMID: 21559998 DOI: 10.1007/s00268-011-1139y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND The main aim of this study was to compare short-term results and long-term outcomes of patients who underwent intraoperative colonic lavage (IOCL) with primary anastomosis with those who had stent placement prior to scheduled surgery for obstructive left-sided colonic cancer (OLCC). METHODS We conducted a prospective, controlled, randomized study of patients diagnosed with OLCC. Patients were divided into two groups: stent and deferred surgery (group 1) and emergency IOCL (group 2). Demographic variables, risk prediction models, postoperative morbidity and mortality, staging, complications due to stent placement, surgical time, clinical follow-up, health costs, and follow-up of survival were recorded. RESULTS Twenty-eight patients (15 group 1 and 13 group 1) were enrolled. The study was suspended upon detecting excess morbidity in group 2. The two groups were homogeneous in clinical and demographic terms. Overall morbidity in group 1 was 2/15 (13.3%) compared with 7/13 (53.8%) in group 2 (p = 0.042). None of the 15 patients in group 1 presented anastomotic dehiscence compared with 4/13 (30.7%) in group 2 (p = 0.035). Surgical site infection was detected in 2 (13.3%) patients in group 1 and in 6 (46.1%) in group 2 (p = 0.096). Postoperative stay was 8 days (IQR 3, group 1) and 10 days (IQR 10, group 2) (p = 0.05). The mean follow-up period was 37.6 months (SD = 16.08) with no differences in survival between the groups. CONCLUSION In our setting, the use of a stent and scheduled surgery is safer than IOCL and is associated with lower morbidity, shorter hospital stay, and equally good long-term survival.
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Affiliation(s)
- M Alcántara
- Colorectal Surgery Unit, Corporación Sanitaria y Universitaria Parc Tauli (Universitat Autónoma de Barcelona), Parc Taulí s/n, 08208 Sabadell, Barcelona, Spain.
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Alcántara M, Serra-Aracil X, Falcó J, Mora L, Bombardó J, Navarro S. Prospective, Controlled, Randomized Study of Intraoperative Colonic Lavage Versus Stent Placement in Obstructive Left-sided Colonic Cancer. World J Surg 2011; 35:1904-10. [DOI: 10.1007/s00268-011-1139-y] [Citation(s) in RCA: 162] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Carcinoma obstruction of the proximal colon cancer and long-term prognosis--obstruction is a predictor of worse outcome in TNM stage II tumor. Int J Colorectal Dis 2010; 25:817-22. [PMID: 20135321 DOI: 10.1007/s00384-010-0904-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/14/2010] [Indexed: 02/04/2023]
Abstract
PURPOSE Colon obstruction is suggested to be a predictor of poor outcome in colon cancer. However, the effect of obstruction on outcome in patients with different tumor-nodes-metastases (TNM) stage cancer has not been fully addressed. The aim of this study is to determine whether colon obstruction predicts surgical and long-term oncologic outcomes in patients with proximal colon cancer. METHODS A total of 1,492 consecutive patients underwent open resection of primary adenocarcinoma of right colon in a single institution between January 1995 and December 2005. Clinical and follow-up data were extracted from a prospective colorectal cancer database. Univariate and multivariate analyses were performed to identify colon obstruction and other predictors of surgical and oncologic outcomes. RESULTS Among 1,492 patients, 306 (20.5%) patients presented with colon obstruction. The rates of surgical morbidity and mortality were greater in patients with an obstruction as compared to patients without an obstruction (22.2% and 3.9% vs. 14.1% and 1.9%; p = 0.0005 and 0.041, respectively). Obstruction predicted a worse long-term disease-free survival (DFS) among patients with stage II-III disease (log-rank test, p = 0.0003). The data were stratified by TNM stage. Obstruction predicted a worse DFS among patients with TNM stage II cancer (598 patients; log-rank test, p = 0.001; Cox regression, p = 0.012), but it was not a predictor in TNM stage III cancer patients (424 patients; p = 0.116; p = 0.108). CONCLUSIONS Colon obstruction was an independent predictor of long-term outcome only in TNM stage II but not in stage III proximal colon cancer. Patients with TNM stage II obstructive colon cancer could be included in future trials of adjuvant therapies.
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Lin CC, Lin JK, Chang SC, Wang HS, Yang SH, Jiang JK, Chen WS, Lin TC. Is adjuvant chemotherapy beneficial to high risk stage II colon cancer? Analysis in a single institute. Int J Colorectal Dis 2009; 24:665-76. [PMID: 19238405 DOI: 10.1007/s00384-009-0634-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2009] [Indexed: 02/04/2023]
Abstract
BACKGROUND Colorectal carcinoma is the most common malignancy of the gastrointestinal tract. It remains controversial for adjuvant chemotherapy in patients with stage II colon cancer. This study was designed to identify the risk factors of tumor recurrence in stage II colon cancer. Furthermore, the benefit of adjuvant chemotherapy for high-risk stage II colorectal cancer will be investigated. MATERIALS AND METHODS From May 1998 until August 2004, 375 patients with stage II (T3N0M0, T4N0M0) colon cancer received curative operation in a single hospital. The clinical data were extracted from the prospectively collected colorectal cancer database. The disease-free survival curves were calculated with Kaplan-Meier's analysis, and the survival difference was determined by log-rank test. The p value less than 0.05 was considered to be significant. RESULTS Of 375 stage II colon cancer, 66 patients received 5-FU-based adjuvant chemotherapy, either oral or intravenous (IV) form. Within the median of 48.5 months of follow-up, recurrence developed in 35 patients (9.3%). T4 lesion (p=0.024), lymphovascular invasion (p=0.022), obstruction at presentation (p=0.008), and mucinous component more than 50% (p=0.032) were associated with significantly decreased disease-free survival. High-risk patients (n=102), but not other patients with stage II colon cancer, benefited from adjuvant therapy (3-year disease-free survival: 96.4% vs. 84.7%, p=0.045; 5-year overall survival: 100% vs. 86.4%, p=0.015). CONCLUSION Adjuvant therapy for high-risk stage II colon cancer may be beneficial, and we suggest adjuvant therapy should be considered in high-risk stage II colon cancer patients.
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Affiliation(s)
- Chun-Chi Lin
- Taipei Veterans General Hospital, Surgery, Taipei, Taiwan
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Alcantara M, Serra X, Bombardó J, Falcó J, Perandreu J, Ayguavives I, Mora L, Hernando R, Navarro S. Colorectal stenting as an effective therapy for preoperative and palliative treatment of large bowel obstruction: 9 years' experience. Tech Coloproctol 2007; 11:316-22. [PMID: 18060531 DOI: 10.1007/s10151-007-0372-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Accepted: 09/20/2007] [Indexed: 01/02/2023]
Abstract
BACKGROUND Since their introduction, selfextending metal stents (SEMS) have established themselves as an option in the treatment of obstructive colorectal cancer. Thanks to stenting, patients traditionally treated with emergency surgery can now be converted to scheduled surgery with mechanical preparation of the colon and primary anastomosis. Stenting represents a valid one-step surgical alternative for intestinal obstruction of the colon. METHODS We performed a prospective study of 95 patients (mean age, 68 years; range 48-94) with large bowel obstruction due to colorectal cancer treated with SEMS placed under fluoroscopic guidance, some as a bridge to surgery (group A) and others with palliative intent (group B). Computed tomography was performed for diagnostic purposes and to study the extent of disease. RESULTS Treatment was palliative in 28 cases (group B) and as a bridge to surgery in 67 (group A). The latter group underwent mechanical preparation of the colon and elective surgery. No patients died as a result of the procedure. In 90 cases (95%), treatment was effective and the obstruction resolved. Complications were 4 cases of perforation, 1 of tenesmus, 4 obstructions and 4 migrations. In 7 cases, a second stent was inserted to allow subsequent scheduled surgery. CONCLUSIONS Self-extending stents resolve colorectal cancer obstruction and allow optimal patient staging and scheduled surgical treatment. Stenting is also a useful option in advanced or irresectable tumors, avoiding the need for surgery and offering good palliation.
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Affiliation(s)
- M Alcantara
- Coloproctology Unit, Sabadell Hospital, Parc Taulí S/N 08208, Sabadell Barcelona, Spain.
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New insights into the role of age and carcinoembryonic antigen in the prognosis of colorectal cancer. Br J Cancer 2007; 98:328-34. [PMID: 18026187 PMCID: PMC2361462 DOI: 10.1038/sj.bjc.6604114] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to verify through relative survival (an estimate of cancer-specific survival) the true prognostic factors of colorectal cancer. The study involved 506 patients who underwent locally radical resection. All the clinical, histological and laboratory parameters were prognostically analysed for both overall and relative survival. This latter was calculated from the expected survival of the general population with identical age, sex and calendar years of observation. Univariate and multivariate analyses were applied to the proportional hazards model. Liver metastases, age, lymph node involvement and depth of bowel wall involvement were independent prognosticators of both overall and relative survival, whereas carcinoembryonic antigen (CEA) was predictive only of relative survival. Increasing age was unfavourably related to overall survival, but mildly protective with regard to relative survival. Three out of the five prognostic factors identified are the cornerstones of the current staging systems, and were confirmed as adequate by the analysis of relative survival. The results regarding age explain the conflicting findings so far obtained from studies considering overall survival only and advise against the adoption of absolute age limits in therapeutic protocols. Moreover, the prechemotherapy CEA level showed a high clinical value.
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Yang SH, Lin JK, Lai CR, Chen CC, Li AFY, Liang WY, Jiang JK. Risk factors for peritoneal dissemination of colorectal cancer. J Surg Oncol 2004; 87:167-73. [PMID: 15334631 DOI: 10.1002/jso.20109] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to clarify the risk factors associated with positive peritoneal dissemination (PPD) of colorectal cancer (CRC). METHODS From June 2000 to September 2002, 143 CRC patients who underwent elective curative (79.0%) or non-curative (21.0%) open laparotomy were prospectively studied. Clinical evaluations including classical factors, colonoscopic evaluation, intraoperative evaluation, and pathological features were recorded. PPD was diagnosed when macro- (MAPD) or microscopic peritoneal dissemination (MIPD) was evident. Positive peritoneal cytology from initially existing ascites or washing lavage indicated MIPD. Various factors were analyzed with univariate (Chi-square test) and then multivariate analyses (logistic regression test) to search for the risk factors of PPD. RESULTS Overall, MIPD, MAPD, and PPD were found in 2.8%, 6.3%, and 9.1%, respectively. Univariate analysis identified age (< or =59 years), CA19-9 (> or = 34.6 U/ml), poor differentiation, circumferential involvement (> or = 3 quadrants), ascites volume (>80 ml), pN+, and pT4 as risk factors of PPD. PPD did not occur in patients with well-differentiated tumors, less circumferential involvement (< 2 quadrants), or no lymph node metastasis. After multivariate analysis, CA19-9 (Odds ratio (95% CI), 8.6 (1.7-43.1)), pT4 (9.0 (1.3-61.0)), and age (5.26 (1.1-25.0)) remained significant risk factors. CONCLUSION CA19-9 (> or = 34.6 U/ml), pT4, and age (< or =59 years) were significant risk factors of PPD.
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Affiliation(s)
- Shung-Haur Yang
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei, Taiwan, Republic of China.
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Wang HS, Lin JK, Mou CY, Lin TC, Chen WS, Jiang JK, Yang SH. Long-term prognosis of patients with obstructing carcinoma of the right colon. Am J Surg 2004; 187:497-500. [PMID: 15041498 DOI: 10.1016/j.amjsurg.2003.12.028] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2002] [Revised: 03/03/2003] [Indexed: 01/02/2023]
Abstract
BACKGROUND The long-term prognosis of patients with colon cancer is dependent on many factors. The aim of this retrospective study was to assess the long-term prognosis of patients with obstructing carcinoma of the right colon. METHODS From 1981 to 1988, 256 patients at the Veterans General Hospital-Taipei who were status postcurative resection of right colon adenocarcinoma were classified as obstruction group (n = 35) or nonobstruction group (n = 221) as appropriate. RESULTS Analysis revealed no differences in age, sex, tumor location, or stage (P >0.05) between the two groups. However, the overall and distant recurrence rates were significant higher in obstructed patients than in nonobstructed patients. Further, long-term crude and cancer-specific survival rates were significantly lower in obstructed patients when examining either overall patient outcome or stage-matched outcomes. Multivariate analysis demonstrated that obstruction and tumor stage were both independent prognostic factors. CONCLUSIONS Obstruction status was an independent prognostic factor for patients with right colon carcinoma. The long-term prognosis of patients with obstructing carcinoma of the right colon was poor.
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Affiliation(s)
- Huann-Sheng Wang
- Division of Colon and Rectal Surgery, Department of Surgery, Veterans General Hospital-Taipei, National Yang-Ming University School of Medicine, Taipei, Taiwan, Republic of China.
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Hayman, James. Emergency admission for surgery predicts disease progression during adjuvant 5-Fluouracil (5-FU)-based chemotherapy. Colorectal Dis 2000; 2:31-5. [PMID: 23577932 DOI: 10.1046/j.1463-1318.2000.00102.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To determine the prognostic significance of a number of variables in patients that receive adjuvant chemotherapy for colorectal cancer. PATIENTS AND METHODS We reviewed the Cancer Centre records of 194 patients who received adjuvant chemotherapy following potentially curative resection of Dukes' B or C colorectal cancer. Eight variables were examined to determine which factor(s) predicted disease progression during the 6-month chemotherapy period. RESULTS Admission for emergency resection (due to bowel obstruction or perforation) rather than elective resection, and a poorly differentiated tumour rather than moderately/well differentiated were independent significant factors in predicting disease progression (P < 0.001 and P=0.011, respectively). However, sex, age, Dukes' stage, number of involved lymph nodes, delays in starting chemotherapy and compliance with chemotherapy regime had no significant effect on 6-month tumour progression. CONCLUSION These preliminary findings confirm data which suggest that emergency admission patients may suffer from intrinsically more aggressive disease than the average population with colorectal cancer.
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Affiliation(s)
- Hayman
- Department of Surgery, North Manchester General Hospital, Manchester, UK, Director of Cancer Services, Maidstone Hospital, Maidstone, UK
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Ratto C, Sofo L, Ippoliti M, Merico M, Doglietto GB, Crucitti F. Prognostic factors in colorectal cancer. Literature review for clinical application. Dis Colon Rectum 1998; 41:1033-49. [PMID: 9715162 DOI: 10.1007/bf02237397] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Identification of prognostic factors is a primary basis for planning the treatment and predicting the outcome of patients with colorectal cancer. Reviewing studies from the literature performed using univariate and multivariate analyses and their own study, the authors critically discuss the prognostic value of the clinicopathologic parameters of the tumor. METHODS Among 853 patients with colorectal tumors seen at the Department of Clinical Surgery of the Catholic University of Rome, Italy, 690 cases that were curatively resected the study. Overall survival rate, related to the clinicopathologic variables, was calculated, and univariate and multivariate analyses were performed. RESULTS Five-year and ten-year overall survival rates were 70 and 55 percent, respectively. Univariate and multivariate analyses showed that node involvement, distant metastases, bowel obstruction, and patient gender are factors independently related to outcome. CONCLUSIONS Data from the literature and the present study suggest that only a few clinical parameters, particularly bowel obstruction, and some pathologic factors (tumor stage, vessels invasion, and tumor ploidy) are related to patient survival rate and are the most reliable prognostic criteria. In prospective clinical studies, any other new pathologic or molecular factors should be matched with these parameters to confirm their value in outcome prediction.
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Affiliation(s)
- C Ratto
- Department of Clinica Chirurgica, Catholic University, Rome, Italy
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Affiliation(s)
- R A Audisio
- European Institute of Oncology (IEO), Milano, Italy
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Audisio RA, Veronesi P, Ferrario L, Cipolla C, Andreoni B, Aapro M. Elective surgery for gastrointestinal tumours in the elderly. Ann Oncol 1997; 8:317-26. [PMID: 9209660 DOI: 10.1023/a:1008294921269] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The geriatric population is expanding and clinical decision-making is often complicated by the effects of ageing. Age should not be the only parameter considered when addressing medical problems. Elderly subjects have been denied surgery because of their presumed higher mortality and morbidity. The present review summarises the physiology of the aged and discusses operative risks, mortality and morbidity rates as well as therapeutic results for the different gastrointestinal sites when affected by cancer. Reports on surgical treatments are revisited and compared to the same procedures delivered to younger patients in the context of the ethical issue of offering the best care to every patient. Elective operations by surgical oncologists are found to be safe with the exception of major liver resections. Complication rates and mean hospital stay do not differ between the two age groups provided the procedure is conducted with the best-known technique in expert hands. A drop in operative morbidity has occurred in the past three decades. Several investigators have emphasised the marked increase in morbidity and mortality experienced by elderly patients when undergoing emergency procedures. Associated diseases have to be properly assessed, as the elderly have a frail physiological balance with a reduced capacity for recovery from traumatic events including major surgical procedures. Careful preoperative evaluation, intraoperative conduct and postoperative care are presently achieved in almost every major hospital. Good clinical practice is based on the balance between probability of cure and toxic effects. Treatment of the elderly should no longer be based on untested beliefs and personal opinions. The elderly should be accrued for prospective clinical evaluation and should not be denied optimal surgical treatment.
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Affiliation(s)
- R A Audisio
- EIO-European Institute of Oncology, Milan, Italy
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Audisio RA, Cazzaniga M, Robertson C, Veronesi P, Andreoni B, Aapro MS. Elective surgery for colorectal cancer in the aged: a clinical-economical evaluation. Br J Cancer 1997; 76:382-4. [PMID: 9252207 PMCID: PMC2224047 DOI: 10.1038/bjc.1997.394] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A series of 56 consecutive patients, referred for surgery to a specialized institute, had elective laparotomies with various surgical procedures aimed at curing locoregional colorectal cancer. Data defining patient and tumour-related preoperative, operative and postoperative variables, including costs, were collected. The study group was divided into two age groups (< 65 vs > or = 65 years), which were similar in terms of patient- and tumour-related variables. Differences were not statistically significant (Pounds 440; 95% exact CI; Pounds -50; 1800). There is no evidence to suggest that there are any total charge differences in treating the two age groups, as confirmed by the cost analysis.
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Affiliation(s)
- R A Audisio
- EIO-European Institute of Oncology, Milan, Italy
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