Skip to main content
SpringerLink
Log in

Ileus caused by obstructing colorectal cancer—impact on long-term survival

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

It is unclear whether obstructing colorectal cancer (CRC) has a worse prognosis than non-obstructing CRC. Of CRC patients, 10–28% present with symptoms of acute obstruction. Previous studies regarding obstruction have been primarily based on short-term outcomes, risk factors and treatment modalities. With this study, we want to determine the long-term survival of patients presenting with acute obstructive CRC.

Methods

This single-centre observational retrospective cohort study includes all CRC patients who underwent surgery between December 2004 and 2010. Patients were divided into two groups: ileus and no ileus. Survival analyses were performed for both groups. Additional survival analyses were performed in patients with and without synchronous metastases. The primary outcome was survival in months.

Results

A total of 1236 patients were included in the analyses. Ileus occurred in 178 patients (14.4%). The 5-year survival for patients with an ileus was 32% and without 60% (P < 0.01). In patients without synchronous metastases, survival with and without an ileus was 40.9 and 68.4%, respectively (P < 0.01). If ileus presentation was complicated by a colon blowout, 5-year survival decreased to 29%. No significant difference was found in patients with synchronous metastases. Survival at 5 years in this subgroup was 10 and 12% for patients with and without an ileus, respectively (P = 0.705).

Conclusions

Patients with obstructive CRC have a reduced short-term overall survival. Also, long-term overall survival is impaired in patients who present with acute obstructive CRC compared to patients without obstruction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Elferink MAG, Koopman M, Rütten H, Van de Velde CJH (2014) Colorectaal carcinoom. Kankerzorg in beeld. Amsterdam: Integraal Kankercentrum Nederland

    Google Scholar 

  2. Ripamonti C, Bruera E (2002) Palliative management of malignant bowel obstruction. Int J Gynecol Cancer 12:135–143

    Article  PubMed  Google Scholar 

  3. Phillips RK, Hittinger R, Fry JS, Fielding LP (1985) Malignant large bowel obstruction. Br J Surg 72:296–302

    Article  PubMed  CAS  Google Scholar 

  4. DeBernardo R (2009) Surgical management of malignant bowel obstruction: strategies toward palliation of patients with advanced cancer. Curr Oncol Rep 11:287–292

    Article  PubMed  Google Scholar 

  5. Pieter J. Tanis, Nuno R. Paulino Pereira, Jeanin E. van Hooft, Esther C.J. Consten, Willem A. Bemelman (2015) Resection of Obstructive Left-Sided Colon Cancer at a National Level: A Prospective Analysis of Short-Term Outcomes in 1,816 Patients. Digestive Surgery 32 (5):317–324.

    Article  PubMed  Google Scholar 

  6. Smothers L, Hynan L, Fleming J, Turnage R, Simmang C, Anthony T (2003) Emergency surgery for colon carcinoma. Dis Colon Rectum 46:24–30

    Article  PubMed  Google Scholar 

  7. Sjo OH, Larsen S, Lunde OC, Nesbakken A (2009) Short term outcome after emergency and elective surgery for colon cancer. Color Dis 11:733–739

    Article  CAS  Google Scholar 

  8. Alves A, Panis Y, Mathieu P, Mantion G, Kwiatkowski F, Slim K et al (2005) Postoperative mortality and morbidity in French patients undergoing colorectal surgery: results of a prospective multicenter study. Arch Surg 140:278–283 discussion 284

    Article  PubMed  Google Scholar 

  9. Kolfschoten NE, Wouters MW, Gooiker GA, Eddes EH, Kievit J, Tollenaar RA et al (2012) Nonelective colon cancer resections in elderly patients: results from the Dutch Surgical Colorectal Audit. Dig Surg 29:412–419

    Article  PubMed  CAS  Google Scholar 

  10. Paulson EC, Mahmoud NN, Wirtalla C, Armstrong K (2010) Acuity and survival in colon cancer surgery. Dis Colon Rectum 53:385–392

    Article  PubMed  Google Scholar 

  11. Cortet M, Grimault A, Cheynel N, Lepage C, Bouvier AM, Faivre J (2013) Patterns of recurrence of obstructing colon cancers after surgery for cure: a population-based study. Color Dis 15:1100–1106

    CAS  Google Scholar 

  12. Tentes AA, Mirelis CG, Kakoliris S, Korakianitis OS, Bougioukas IG, Tsalkidou EG et al (2009) Results of surgery for colorectal carcinoma with obstruction. Langenbeck’s Arch Surg 394:49–53

    Article  Google Scholar 

  13. National Collaborating Centre for Cancer (UK) (2011) Colorectal cancer: the diagnosis and management of colorectal cancer. National Collaborating Centre for Cancer (UK), National Institute for Health and Clinical Excellence: Guidance, Cardiff

    Google Scholar 

  14. Wang HS, Lin JK, Mou CY, Lin TC, Chen WS, Jiang JK, Yang SH (2004) Long-term prognosis of patients with obstructing carcinoma of the right colon. Am J Surg 187:497–500

    Article  PubMed  Google Scholar 

  15. Atsushi I, Mitsuyoshi O, Kazuya Y, Syuhei K, Noriyuki K, Masashi M et al (2016) Long-term outcomes and prognostic factors of patients with obstructive colorectal cancer: a multicenter retrospective cohort study. World J Gastroenterol 22:5237–5245

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  16. Biondo S, Kreisler E, Millan M, Fraccalvieri D, Golda T, Marti Rague J et al (2008) Differences in patient postoperative and long-term outcomes between obstructive and perforated colonic cancer. Am J Surg 195:427–432

    Article  PubMed  Google Scholar 

  17. Moolla Z, Madiba TE (2014) Trends in demographics and management of obstructing colorectal cancer. World J Surg 38:2466–2470

    Article  PubMed  Google Scholar 

  18. Serpell JW, McDermott FT, Katrivessis H, Hughes ES (1989) Obstructing carcinomas of the colon. Br J Surg 76:965–969

    Article  PubMed  CAS  Google Scholar 

  19. Lee YM, Law WL, Chu KW, Poon RT (2001) Emergency surgery for obstructing colorectal cancers: a comparison between right-sided and left-sided lesions. J Am Coll Surg 192:719–725

    Article  PubMed  CAS  Google Scholar 

  20. Umpleby HC, Williamson RC (1984) Survival in acute obstructing colorectal carcinoma. Dis Colon Rectum 27:299–304

    Article  PubMed  CAS  Google Scholar 

  21. McArdle CS, McMillan DC, Hole DJ (2006) The impact of blood loss, obstruction and perforation on survival in patients undergoing curative resection for colon cancer. Br J Surg 93:483–488

    Article  PubMed  CAS  Google Scholar 

  22. Renehan AG, Egger M, Saunders MP, O’Dwyer ST (2002) Impact on survival of intensive follow up after curative resection for colorectal cancer: systematic review and meta-analysis of randomised trials. BMJ 324:813

    Article  PubMed  PubMed Central  Google Scholar 

  23. Scholefield JH, Robinson MH, Mangham CM, Hardcastle JD (1998) Screening for colorectal cancer reduces emergency admissions. Eur J Surg Oncol 24:47–50

    Article  PubMed  CAS  Google Scholar 

  24. Rosati G, Ambrosini G, Barni S, Andreoni B, Corradini G, Luchena G, Daniele B, Gaion F, Oliverio G, Duro M, Martignoni G, Pinna N, Sozzi P, Pancera G, Solina G, Pavia G, Pignata S, Johnson F, Labianca R, Apolone G, Zaniboni A, Monteforte M, Negri E, Torri V, Mosconi P, Fossati R (2016) A randomized trial of intensive versus minimal surveillance of patients with resected Dukes B2-C colorectal carcinoma. Ann Oncol 27:274–280

    Article  PubMed  CAS  Google Scholar 

  25. Glover C, Douse P, Kane P, Karani J, Meire H, Mohammadtaghi S, Allen-Mersh TG (2002) Accuracy of investigations for asymptomatic colorectal liver metastases. Dis Colon Rectum 45:476–484.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Amphia Hospital, Molengracht 21, 4818 CK, Breda, The Netherlands

    Jeske R. E. Boeding, Winesh Ramphal, Rogier M. P. H. Crolla, Paul D. Gobardhan & Jennifer M. J. Schreinemakers

  2. Department of Research and Epidemiology, Amphia Hospital Breda, Breda, The Netherlands

    Leandra J. M. Boonman-de Winter

Authors
  1. Jeske R. E. Boeding
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Winesh Ramphal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rogier M. P. H. Crolla
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Leandra J. M. Boonman-de Winter
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Paul D. Gobardhan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jennifer M. J. Schreinemakers
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jeske R. E. Boeding.

Ethics declarations

The Medical Research Ethics Committees United (MEC-U) was consulted for ethical approval. They confirmed that this study (reference number W17,073), the Medical Research Involving Human Subject Act (WMO), does not apply. The institutional review board (AMOA) of Amphia Hospital confirmed that no formal written waiver for ethics approval was required.

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Boeding, J.R.E., Ramphal, W., Crolla, R.M.P.H. et al. Ileus caused by obstructing colorectal cancer—impact on long-term survival. Int J Colorectal Dis 33, 1393–1400 (2018). https://doi.org/10.1007/s00384-018-3132-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-018-3132-5

Keywords

Search

Navigation