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Erschienen in:

03.01.2024 | Research

Relief of Obstruction in Left-Sided Obstructive Colon Cancer: Nationwide Analysis of Applied Treatment in the Palliative Setting

verfasst von: J. M. L. Sijmons, B. Zamaray, J. V. Veld, A. K. Warps, J. W. T. Dekker, J. B. Tuynman, H. L. van Westreenen, E. C. J. Consten, P. J. Tanis

Erschienen in: Journal of Gastrointestinal Cancer | Ausgabe 2/2024

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Abstract

Background

For relief of bowel obstruction in left-sided obstructive colon cancer (LSOCC), a self-expandable metal stent (SEMS) or decompressing stoma (DS) can be placed. In a curative setting, these two strategies have been extensively studied as a bridge to elective resection. Guidelines recommend SEMS as the preferred option in the palliative setting, but adherence in daily practice is unknown. Therefore, this study aimed to gain more insight into patients with LSOCC who received palliative treatment with SEMS or DS at a national level.

Methods

A retrospective population-based cohort study was conducted in the Netherlands. Data from the Netherlands Cancer Registry (NCR) on all patients with LSOCC treated with DS or SEMS not followed by resection of the primary tumour between January 1, 2015, and December 31, 2019, were analysed. Type of treatment (DS or SEMS) for different clinical scenarios, was the main outcome of this study, and was also evaluated over the years (2015–2019).

Results

Palliative treatment with SEMS or DS for LSOCC was performed in 1077 patients, of whom 79.2% had metastatic disease (M1). Patients without metastatic disease (M0) were older (≥ 80 years M0 67.4%, M1 25.3%, P < 0.001), had a worse clinical condition (ASA III 51.4% versus 36.37%, ASA IV-V 13.3% versus 4.0% P < 0.001) and presented with higher tumour stage (cT4 55.4% versus 33.5%, % P < 0.001). DS was performed in 91.5% of the patients and SEMS in 8.5%. The proportion of DS did not significantly differ between patients with M1 and M0 (91.8% vs. 90.2% respectively, P = 0.525). No increase in SEMS application was observed over the years, with a stable overall proportion of DS of 91–92% per year. In the multivariable analyses, ninety-day mortality and overall survival were not significantly different between SEMS and DS.

Conclusions

This study revealed that DS was the primary treatment modality for palliative management of LSOCC in the Netherlands between 2015 and 2019, while the guidelines recommended SEMS as preferred treatment. For patients with LSOCC eligible for stenting in the palliative setting, SEMS placement should become more available and accessible as the preferred treatment option, to avoid a stoma in the terminal phase of life.
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Literatur
1.
Zurück zum Zitat Amelung FJ, Burghgraef TA, Tanis PJ, van Hooft JE, Ter Borg F, Siersema PD, et al. Critical appraisal of oncological safety of stent as bridge to Surgery in left-sided obstructing colon Cancer; a systematic review and meta-analysis. Crit Rev Oncol Hematol. 2018;131:66–75.CrossRefPubMed Amelung FJ, Burghgraef TA, Tanis PJ, van Hooft JE, Ter Borg F, Siersema PD, et al. Critical appraisal of oncological safety of stent as bridge to Surgery in left-sided obstructing colon Cancer; a systematic review and meta-analysis. Crit Rev Oncol Hematol. 2018;131:66–75.CrossRefPubMed
2.
Zurück zum Zitat Tan L, Liu ZL, Ran MN, Tang LH, Pu YJ, Liu YL, et al. Comparison of the prognosis of four different treatment strategies for acute left malignant colonic obstruction: a systematic review and network meta-analysis. World J Emerg Surg. 2021;16(1):11.CrossRefPubMedPubMedCentral Tan L, Liu ZL, Ran MN, Tang LH, Pu YJ, Liu YL, et al. Comparison of the prognosis of four different treatment strategies for acute left malignant colonic obstruction: a systematic review and network meta-analysis. World J Emerg Surg. 2021;16(1):11.CrossRefPubMedPubMedCentral
3.
Zurück zum Zitat Faragher IG, Chaitowitz IM, Stupart DA. Long-term results of palliative stenting or Surgery for incurable obstructing colon Cancer. Colorectal Dis. 2008;10(7):668–72.CrossRefPubMed Faragher IG, Chaitowitz IM, Stupart DA. Long-term results of palliative stenting or Surgery for incurable obstructing colon Cancer. Colorectal Dis. 2008;10(7):668–72.CrossRefPubMed
4.
Zurück zum Zitat Veld JV, Amelung FJ, Borstlap WAA, van Halsema EE, Consten ECJ, Siersema PD, et al. Comparison of Decompressing Stoma vs Stent as a bridge to Surgery for left-sided obstructive Colon Cancer. JAMA Surg. 2020;155(3):206–15.CrossRefPubMedPubMedCentral Veld JV, Amelung FJ, Borstlap WAA, van Halsema EE, Consten ECJ, Siersema PD, et al. Comparison of Decompressing Stoma vs Stent as a bridge to Surgery for left-sided obstructive Colon Cancer. JAMA Surg. 2020;155(3):206–15.CrossRefPubMedPubMedCentral
5.
Zurück zum Zitat Liao C, Qin Y. Factors associated with stoma quality of life among stoma patients. Int J Nurs Sci. 2014;1(2):196–201. Liao C, Qin Y. Factors associated with stoma quality of life among stoma patients. Int J Nurs Sci. 2014;1(2):196–201.
6.
Zurück zum Zitat Silva JO, Gomes P, Gonçalves D, Viana C, Nogueira F, Goulart A, et al. Quality of life (QoL) among Ostomized patients – a cross-sectional study using stoma-care QoL questionnaire about the influence of some clinical and demographic data on patients’ QoL. J Coloproctology. 2019;39(1):48–55.CrossRef Silva JO, Gomes P, Gonçalves D, Viana C, Nogueira F, Goulart A, et al. Quality of life (QoL) among Ostomized patients – a cross-sectional study using stoma-care QoL questionnaire about the influence of some clinical and demographic data on patients’ QoL. J Coloproctology. 2019;39(1):48–55.CrossRef
7.
Zurück zum Zitat Young CJ, De-Loyde KJ, Young JM, Solomon MJ, Chew EH, Byrne CM, et al. Improving quality of life for people with Incurable large-bowel obstruction: Randomized Control Trial of Colonic stent insertion. Dis Colon Rectum. 2015;58(9):838–49.CrossRefPubMed Young CJ, De-Loyde KJ, Young JM, Solomon MJ, Chew EH, Byrne CM, et al. Improving quality of life for people with Incurable large-bowel obstruction: Randomized Control Trial of Colonic stent insertion. Dis Colon Rectum. 2015;58(9):838–49.CrossRefPubMed
8.
Zurück zum Zitat Suzuki H, Tsujinaka S, Sato Y, Miura T, Shibata C. Oncologic impact of colonic stents for obstructive left-sided colon Cancer. World J Clin Oncol. 2023;14(1):1–12.CrossRefPubMedPubMedCentral Suzuki H, Tsujinaka S, Sato Y, Miura T, Shibata C. Oncologic impact of colonic stents for obstructive left-sided colon Cancer. World J Clin Oncol. 2023;14(1):1–12.CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat van Halsema EE, van Hooft JE, Small AJ, Baron TH, García-Cano J, Cheon JH, et al. Perforation in colorectal stenting: a meta-analysis and a search for risk factors. Gastrointest Endosc. 2014;79(6):970–82. e7; quiz 83.e2, 83.e5.CrossRefPubMed van Halsema EE, van Hooft JE, Small AJ, Baron TH, García-Cano J, Cheon JH, et al. Perforation in colorectal stenting: a meta-analysis and a search for risk factors. Gastrointest Endosc. 2014;79(6):970–82. e7; quiz 83.e2, 83.e5.CrossRefPubMed
10.
Zurück zum Zitat Veld J, Umans D, van Halsema E, Amelung F, Fernandes D, Lee MS, et al. Self-expandable metal stent (SEMS) placement or emergency Surgery as palliative treatment for obstructive Colorectal cancer: a systematic review and meta-analysis. Crit Rev Oncol Hematol. 2020;155:103110.CrossRefPubMed Veld J, Umans D, van Halsema E, Amelung F, Fernandes D, Lee MS, et al. Self-expandable metal stent (SEMS) placement or emergency Surgery as palliative treatment for obstructive Colorectal cancer: a systematic review and meta-analysis. Crit Rev Oncol Hematol. 2020;155:103110.CrossRefPubMed
11.
Zurück zum Zitat van Hooft JE, Veld JV, Arnold D, Beets-Tan RGH, Everett S, Götz M, et al. Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2020. Endoscopy. 2020;52(5):389–407.CrossRefPubMed van Hooft JE, Veld JV, Arnold D, Beets-Tan RGH, Everett S, Götz M, et al. Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2020. Endoscopy. 2020;52(5):389–407.CrossRefPubMed
13.
Zurück zum Zitat Venderbosch S, de Wilt JH, Teerenstra S, Loosveld OJ, van Bochove A, Sinnige HA, et al. Prognostic value of resection of primary Tumor in patients with stage IV Colorectal cancer: retrospective analysis of two randomized studies and a review of the literature. Ann Surg Oncol. 2011;18(12):3252–60.CrossRefPubMedPubMedCentral Venderbosch S, de Wilt JH, Teerenstra S, Loosveld OJ, van Bochove A, Sinnige HA, et al. Prognostic value of resection of primary Tumor in patients with stage IV Colorectal cancer: retrospective analysis of two randomized studies and a review of the literature. Ann Surg Oncol. 2011;18(12):3252–60.CrossRefPubMedPubMedCentral
14.
Zurück zum Zitat van der Kruijssen DEW, Elias SG, Vink GR, van Rooijen KL, t, Lam-Boer J, Mol L et al. Sixty-Day Mortality of Patients With Metastatic Colorectal Cancer Randomized to Systemic Treatment vs Primary Tumor Resection Followed by Systemic Treatment: The CAIRO4 Phase 3 Randomized Clinical Trial. JAMA Surg. 2021;156(12):1093 – 101. van der Kruijssen DEW, Elias SG, Vink GR, van Rooijen KL, t, Lam-Boer J, Mol L et al. Sixty-Day Mortality of Patients With Metastatic Colorectal Cancer Randomized to Systemic Treatment vs Primary Tumor Resection Followed by Systemic Treatment: The CAIRO4 Phase 3 Randomized Clinical Trial. JAMA Surg. 2021;156(12):1093 – 101.
15.
Zurück zum Zitat Kanemitsu Y, Shitara K, Mizusawa J, Hamaguchi T, Shida D, Komori K, et al. Primary Tumor Resection Plus Chemotherapy Versus Chemotherapy alone for Colorectal Cancer patients with asymptomatic, synchronous unresectable metastases (JCOG1007; iPACS): a Randomized Clinical Trial. J Clin Oncol. 2021;39(10):1098–107.CrossRefPubMedPubMedCentral Kanemitsu Y, Shitara K, Mizusawa J, Hamaguchi T, Shida D, Komori K, et al. Primary Tumor Resection Plus Chemotherapy Versus Chemotherapy alone for Colorectal Cancer patients with asymptomatic, synchronous unresectable metastases (JCOG1007; iPACS): a Randomized Clinical Trial. J Clin Oncol. 2021;39(10):1098–107.CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Zhang J, Zhu H, Yang W, Liu X, Zhang D, Jiang X, et al. Endoscopic stent versus diverting stoma as a bridge to Surgery for obstructive Colorectal cancer: a systematic review and meta-analysis. Langenbecks Arch Surg. 2022;407(8):3275–85.CrossRefPubMedPubMedCentral Zhang J, Zhu H, Yang W, Liu X, Zhang D, Jiang X, et al. Endoscopic stent versus diverting stoma as a bridge to Surgery for obstructive Colorectal cancer: a systematic review and meta-analysis. Langenbecks Arch Surg. 2022;407(8):3275–85.CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat Pattarajierapan S, Manomayangoon C, Tipsuwannakul P, Khomvilai S. Comparison of colonic stenting and stoma creation as palliative treatment for incurable malignant colonic obstruction. JGH Open. 2022;6(9):630–6.CrossRefPubMedPubMedCentral Pattarajierapan S, Manomayangoon C, Tipsuwannakul P, Khomvilai S. Comparison of colonic stenting and stoma creation as palliative treatment for incurable malignant colonic obstruction. JGH Open. 2022;6(9):630–6.CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat Mangone L, Pinto C, Mancuso P, Ottone M, Bisceglia I, Chiaranda G, et al. Colon Cancer survival differs from right side to left side and lymph node harvest number matter. BMC Public Health. 2021;21(1):906.CrossRefPubMedPubMedCentral Mangone L, Pinto C, Mancuso P, Ottone M, Bisceglia I, Chiaranda G, et al. Colon Cancer survival differs from right side to left side and lymph node harvest number matter. BMC Public Health. 2021;21(1):906.CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Petrelli F, Tomasello G, Borgonovo K, Ghidini M, Turati L, Dallera P, et al. Prognostic survival Associated with Left-Sided vs right-sided Colon Cancer: a systematic review and Meta-analysis. JAMA Oncol. 2017;3(2):211–9.CrossRefPubMed Petrelli F, Tomasello G, Borgonovo K, Ghidini M, Turati L, Dallera P, et al. Prognostic survival Associated with Left-Sided vs right-sided Colon Cancer: a systematic review and Meta-analysis. JAMA Oncol. 2017;3(2):211–9.CrossRefPubMed
20.
Zurück zum Zitat Baran B, Mert Ozupek N, Yerli Tetik N, Acar E, Bekcioglu O, Baskin Y. Difference between left-sided and right-sided Colorectal Cancer: a focused review of literature. Gastroenterol Res. 2018;11(4):264–73.CrossRef Baran B, Mert Ozupek N, Yerli Tetik N, Acar E, Bekcioglu O, Baskin Y. Difference between left-sided and right-sided Colorectal Cancer: a focused review of literature. Gastroenterol Res. 2018;11(4):264–73.CrossRef
21.
Zurück zum Zitat Zhao XD, Cai BB, Cao RS, Shi RH. Palliative treatment for incurable malignant colorectal obstructions: a meta-analysis. World J Gastroenterol. 2013;19(33):5565–74.CrossRefPubMedPubMedCentral Zhao XD, Cai BB, Cao RS, Shi RH. Palliative treatment for incurable malignant colorectal obstructions: a meta-analysis. World J Gastroenterol. 2013;19(33):5565–74.CrossRefPubMedPubMedCentral
22.
Zurück zum Zitat Sloothaak DA, van den Berg MW, Dijkgraaf MG, Fockens P, Tanis PJ, van Hooft JE, et al. Oncological outcome of malignant colonic obstruction in the Dutch Stent-In 2 trial. Br J Surg. 2014;101(13):1751–7.CrossRefPubMed Sloothaak DA, van den Berg MW, Dijkgraaf MG, Fockens P, Tanis PJ, van Hooft JE, et al. Oncological outcome of malignant colonic obstruction in the Dutch Stent-In 2 trial. Br J Surg. 2014;101(13):1751–7.CrossRefPubMed
23.
Zurück zum Zitat van Hooft JE, Fockens P, Marinelli AW, Bossuyt PM, Bemelman WA. Premature closure of the Dutch stent-in I study. Lancet. 2006;368(9547):1573–4.CrossRefPubMed van Hooft JE, Fockens P, Marinelli AW, Bossuyt PM, Bemelman WA. Premature closure of the Dutch stent-in I study. Lancet. 2006;368(9547):1573–4.CrossRefPubMed
24.
Zurück zum Zitat Veld JV, Amelung FJ, Borstlap WAA, van Eise E, Consten ECJ, Siersema PD, et al. Changes in management of left-sided obstructive Colon Cancer: National Practice and Guideline implementation. J Natl Compr Canc Netw. 2019;17(12):1512–20.CrossRefPubMed Veld JV, Amelung FJ, Borstlap WAA, van Eise E, Consten ECJ, Siersema PD, et al. Changes in management of left-sided obstructive Colon Cancer: National Practice and Guideline implementation. J Natl Compr Canc Netw. 2019;17(12):1512–20.CrossRefPubMed
Metadaten
Titel
Relief of Obstruction in Left-Sided Obstructive Colon Cancer: Nationwide Analysis of Applied Treatment in the Palliative Setting
verfasst von
J. M. L. Sijmons
B. Zamaray
J. V. Veld
A. K. Warps
J. W. T. Dekker
J. B. Tuynman
H. L. van Westreenen
E. C. J. Consten
P. J. Tanis
Publikationsdatum
03.01.2024
Verlag
Springer US
Erschienen in
Journal of Gastrointestinal Cancer / Ausgabe 2/2024
Print ISSN: 1941-6628
Elektronische ISSN: 1941-6636
DOI
https://doi.org/10.1007/s12029-023-01010-6

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