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Tumor characteristics associated with malignant large bowel obstruction in stage IV colorectal cancer patients undergoing chemotherapy

International Journal of Colorectal Disease volume 31, pages 1767–1774 (2016)Cite this article

Abstract

Purpose

Little is known about predictable clinical factors associated with the occurrence of malignant large bowel obstruction (MLBO) in incurable stage IV colorectal cancer (CRC) patients undergoing medical treatment. This study investigates the clinical characteristics associated with MLBO that occurred while patients with stage IV CRC were receiving chemotherapy.

Methods

A total of 216 patients who were diagnosed with stage IV CRC without bowel obstruction and who received chemotherapy between May 2005 and June 2012 were retrospectively included in this study. Patients were divided into an “obstruction group” and a “non-obstruction group” based on whether they did or did not develop MLBO during chemotherapy or follow-up, respectively. The initial endoscopic findings and clinical information were retrospectively reviewed and compared between the two groups.

Results

Forty-six patients (21.3 %) developed MLBO during the treatment or follow-up periods. The mean duration between diagnosis and MLBO was 9.8 ± 9.3 months. After adjusting for clinically relevant factors, MLBO development was independently associated with the following factors: higher initial tumor-occupying circumference (HR 1.030 [95 % CI, 1.012–1.049], P = 0.001), longer initial horizontal tumor width (HR 1.035 [95 % CI, 1.011–1.059], P = 0.004), primary tumor location at a turning point in the colon (HR 2.404 [95 % CI, 1.185–4.877], P = 0.015), and the presence of primary tumor ulceration at presentation (HR 3.767 [95 % CI, 1.882–7.538], P < 0.001). MLBO development was not associated with tumor response to chemotherapy.

Conclusion

In patients with stage IV CRC, MLBO development during chemotherapy treatment is associated with tumor ulceration, location, circumference, and width at diagnosis.

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References

  1. Jimenez-Perez J, Casellas J, Garcia-Cano J, Vandervoort J, Garcia-Escribano OR, Barcenilla J, Delgado AA, Goldberg P, Gonzalez-Huix F, Vazquez-Astray E, Meisner S (2011) Colonic stenting as a bridge to surgery in malignant large-bowel obstruction: a report from two large multinational registries. Am J Gastroenterol 106(12):2174–2180. doi:10.1038/ajg.2011.360

    CAS  Article  PubMed  Google Scholar 

  2. Phillips RK, Hittinger R, Fry JS, Fielding LP (1985) Malignant large bowel obstruction. The British journal of surgery 72(4):296–302

    CAS  Article  PubMed  Google Scholar 

  3. Roeland E, von Gunten CF (2009) Current concepts in malignant bowel obstruction management. Curr Oncol Rep 11(4):298–303

    Article  PubMed  Google Scholar 

  4. Ripamonti CI, Easson AM, Gerdes H (2008) Management of malignant bowel obstruction. Eur J Cancer 44(8):1105–1115. doi:10.1016/j.ejca.2008.02.028

    Article  PubMed  Google Scholar 

  5. Woolfson RG, Jennings K, Whalen GF (1997) Management of bowel obstruction in patients with abdominal cancer. Arch Surg 132(10):1093–1097

    CAS  Article  PubMed  Google Scholar 

  6. Poultsides GA, Servais EL, Saltz LB, Patil S, Kemeny NE, Guillem JG, Weiser M, Temple LK, Wong WD, Paty PB (2009) Outcome of primary tumor in patients with synchronous stage IV colorectal cancer receiving combination chemotherapy without surgery as initial treatment. J Clin Oncol Off J Am Soc Clin Oncol 27(20):3379–3384. doi:10.1200/JCO.2008.20.9817

    Article  Google Scholar 

  7. Nitzkorski JR, Farma JM, Watson JC, Siripurapu V, Zhu F, Matteotti RS, Sigurdson ER (2012) Outcome and natural history of patients with stage IV colorectal cancer receiving chemotherapy without primary tumor resection. Ann Surg Oncol 19(2):379–383. doi:10.1245/s10434-011-2028-1

    Article  PubMed  Google Scholar 

  8. Dalal KM, Gollub MJ, Miner TJ, Wong WD, Gerdes H, Schattner MA, Jaques DP, Temple LK (2011) Management of patients with malignant bowel obstruction and stage IV colorectal cancer. J Palliat Med 14(7):822–828. doi:10.1089/jpm.2010.0506

    Article  PubMed  Google Scholar 

  9. Wright FC, Chakraborty A, Helyer L, Moravan V, Selby D (2010) Predictors of survival in patients with non-curative stage IV cancer and malignant bowel obstruction. J Surg Oncol 101(5):425–429. doi:10.1002/jso.21492

    CAS  PubMed  Google Scholar 

  10. Rosen SA, Buell JF, Yoshida A, Kazsuba S, Hurst R, Michelassi F, Millis JM, Posner MC (2000) Initial presentation with stage IV colorectal cancer: how aggressive should we be? Arch Surg 135(5):530–534 discussion 534–535

    CAS  Article  PubMed  Google Scholar 

  11. Galizia G, Lieto E, Orditura M, Castellano P, Imperatore V, Pinto M, Zamboli A (2008) First-line chemotherapy vs bowel tumor resection plus chemotherapy for patients with unresectable synchronous colorectal hepatic metastases. Arch Surg 143(4):352–358 . doi:10.1001/archsurg.143.4.352discussion 358

    Article  PubMed  Google Scholar 

  12. Rabeneck L, Paszat LF, Rothwell DM, He J (2005) Temporal trends in new diagnoses of colorectal cancer with obstruction, perforation, or emergency admission in Ontario: 1993–2001. Am J Gastroenterol 100(3):672–676. doi:10.1111/j.1572-0241.2005.41228.x

    Article  PubMed  Google Scholar 

  13. Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, Dancey J, Arbuck S, Gwyther S, Mooney M, Rubinstein L, Shankar L, Dodd L, Kaplan R, Lacombe D, Verweij J (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45(2):228–247. doi:10.1016/j.ejca.2008.10.026

    CAS  Article  PubMed  Google Scholar 

  14. Krouse RS, McCahill LE, Easson AM, Dunn GP (2002) When the sun can set on an unoperated bowel obstruction: management of malignant bowel obstruction. J Am Coll Surg 195(1):117–128

    Article  PubMed  Google Scholar 

  15. Sarela AI, Guthrie JA, Seymour MT, Ride E, Guillou PJ, O'Riordain DS (2001) Non-operative management of the primary tumour in patients with incurable stage IV colorectal cancer. The British journal of surgery 88(10):1352–1356. doi:10.1046/j.0007-1323.2001.01915.x

    CAS  Article  PubMed  Google Scholar 

  16. Pfitzner J (1976) Poiseuille and his law. Anaesthesia 31(2):273–275

    CAS  Article  PubMed  Google Scholar 

  17. Winner M, Mooney SJ, Hershman DL, Feingold DL, Allendorf JD, Wright JD, Neugut AI (2013) Incidence and predictors of bowel obstruction in elderly patients with stage IV colon cancer: a population-based cohort study. JAMA surgery 148(8):715–722. doi:10.1001/jamasurg.2013.1

    Article  PubMed  PubMed Central  Google Scholar 

  18. Wolmark N, Wieand HS, Rockette HE, Fisher B, Glass A, Lawrence W, Lerner H, Cruz AB, Volk H, Shibata H, et al. (1983) The prognostic significance of tumor location and bowel obstruction in dukes B and C colorectal cancer. Findings from the NSABP clinical trials. Ann Surg 198(6):743–752

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  19. Scoggins CR, Meszoely IM, Blanke CD, Beauchamp RD, Leach SD (1999) Nonoperative management of primary colorectal cancer in patients with stage IV disease. Ann Surg Oncol 6(7):651–657

    CAS  Article  PubMed  Google Scholar 

  20. Park YJ, Park KJ, Park JG, Lee KU, Choe KJ, Kim JP (1999) Prognostic factors in 2230 Korean colorectal cancer patients: analysis of consecutively operated cases. World J Surg 23(7):721–726

    CAS  Article  PubMed  Google Scholar 

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Affiliations

  1. Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea

    Duk Hwan Kim, Bun Kim, Jae Hyuk Choi, Soo Jung Park, Sung Pil Hong, Jae Hee Cheon, Won Ho Kim & Tae Il Kim

  2. Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, South Korea

    Duk Hwan Kim

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  1. Duk Hwan Kim
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  2. Bun Kim
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  3. Jae Hyuk Choi
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  7. Won Ho Kim
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Correspondence to Won Ho Kim or Tae Il Kim.

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Won Ho Kim and Tae Il Kim contributed equally to this work as cocorresponding authors.

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Kim, D.H., Kim, B., Choi, J.H. et al. Tumor characteristics associated with malignant large bowel obstruction in stage IV colorectal cancer patients undergoing chemotherapy. Int J Colorectal Dis 31, 1767–1774 (2016). https://doi.org/10.1007/s00384-016-2638-y

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Keywords

  • Colorectal cancer
  • Obstruction
  • Unresectable
  • Chemotherapy