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

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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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Data Availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

LSOCC:

Left-sided obstructive colon cancer

SEMS:

Self-expandable metal stent

DS:

Decompressing stoma

NCR:

Netherlands Cancer Registry

ASA:

American Society of Anaesthesiologists

OR:

Odds ratio

95% CI:

95% confidence interval

HR:

Hazard Ratio

M1:

Patients with metastatic disease

M0:

Patients without metastatic disease

References

  1. 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.

    Article  PubMed  Google Scholar 

  2. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  3. 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.

    Article  PubMed  CAS  Google Scholar 

  4. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Liao C, Qin Y. Factors associated with stoma quality of life among stoma patients. Int J Nurs Sci. 2014;1(2):196–201.

    Google Scholar 

  6. 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.

    Article  Google Scholar 

  7. 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.

    Article  PubMed  Google Scholar 

  8. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  9. 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.

    Article  PubMed  Google Scholar 

  10. 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.

    Article  PubMed  Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. Richtlijn Colorectaal Carcinoom CRC. 2023 [Available from: https://richtlijnendatabase.nl/richtlijn/colorectaal_carcinoom_crc/primaire_behandeling_coloncarcinoom_bij_crc/acute_presentatie_cc_bij_crc.html.

  13. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  14. 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. 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.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  16. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  17. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  18. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  19. 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.

    Article  PubMed  Google Scholar 

  20. 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.

    Article  CAS  Google Scholar 

  21. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  22. 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.

    Article  PubMed  CAS  Google Scholar 

  23. 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.

    Article  PubMed  Google Scholar 

  24. 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.

    Article  PubMed  Google Scholar 

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Acknowledgements

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Funding

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Author information

Author notes

  1. J.M.L. Sijmons and B. Zamaray contributed equally to this work.

Authors and Affiliations

  1. Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 Amsterdam, Amsterdam, The Netherlands

    J. M. L. Sijmons, B. Zamaray & P. J. Tanis

  2. Dutch Institute for Clinical Auditing, Rijsburgerweg 10, Leiden, The Netherlands

    J. M. L. Sijmons

  3. Cancer Center Amsterdam, Treatment and quality of life, De Boelelaan 1118, Amsterdam, The Netherlands

    J. M. L. Sijmons, B. Zamaray & P. J. Tanis

  4. Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands

    J. V. Veld

  5. Department of Surgery, University Medical Centre Groningen, Hanzeplein 1, Groningen, The Netherlands

    A. K. Warps & E. C. J. Consten

  6. Department of Surgery, Reinier de Graaf Groep, Reinier de Graafweg 5, Delft, The Netherlands

    J. W. T. Dekker

  7. Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands

    J. B. Tuynman

  8. Department of Surgery, Isala Hospital, Dokter van Heesweg 2, Zwolle, The Netherlands

    H. L. van Westreenen

  9. Meander Medical Centre, Department of Surgery, Maatweg 3, Amersfoort, The Netherlands

    E. C. J. Consten

  10. Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC, Doctor Molewaterplein 40, Rotterdam, 3015 GD, the Netherlands

    P. J. Tanis

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  1. J. M. L. Sijmons
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Contributions

JS and BZ analysed the data, JS, BZ and PT interpreted the patient data and wrote the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to P. J. Tanis.

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Following Dutch national law, no ethical approval was required for this study.

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Following Dutch national law, no informed consent was required for this study.

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The authors declare no competing interests.

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Sijmons, J.M.L., Zamaray, B., Veld, J.V. et al. Relief of Obstruction in Left-Sided Obstructive Colon Cancer: Nationwide Analysis of Applied Treatment in the Palliative Setting. J Gastrointest Canc (2024). https://doi.org/10.1007/s12029-023-01010-6

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