Waiting Time to Chemotherapy in Obstructed Metastatic Colorectal Cancer: Comparative Analysis of 3 Surgical Procedures
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Abstract
Background: Surgical treatments in obstructed metastatic colorectal cancer (CRC) include primary resection with anastomosis, loop colostomy and
Hartmann’s procedure. Recovery of these surgeries should not delay the conversion chemotherapy for bridging to metastectomy that improve the survival time.
Objective: To compare the postoperative waiting time for chemotherapy, length of stay, complication, and survival time between 3 groups of surgical procedures in obstructed metastatic CRC.
Material and methods: A retrospective cohort study was conducted among 50 patients with obstructed metastatic CRC who underwent surgery and received chemotherapy in Nan Hospital from 2011 to 2020. Length of stay, waiting time for chemotherapy, and survival time were compared between 3 surgical procedures using one-way ANOVA and Kruskal-Wallis test.
Results: The mean age was 62.4 years (SD 10.2, range 45−85) and 32 cases were male. Most of CRC located at rectum (34%), descending colon (26%) and sigmoid colon (18%). Metastatic sites were liver (74%) and lung (40%). Surgeries included 24 cases of primary resection with anastomosis, 19 cases of loop colostomy and 7 cases of Hartmann’s procedure. Length of stay were averaged 11.0 days (SD 4.4), 7.3 days (SD 2.9) and 7.7 days (SD 2.4) respectively (p=0.002). The mean waiting time for chemotherapy was 25.3 days (SD 6.6) in anastomosis group, 29.8 days (SD 14.1) in loop colostomy and 23.0 days (SD 27.4) in Hartmann’s procedure (p=0.416). The median survival time were 372 days (IQR 256, 661), 373 days (IQR 338, 545) and 657 days (IQR 245, 786) respectively (p=0.874). There were 1 case of sepsis and 1 case of surgical site infection in the anastomosis group, and 1 case of respiratory failure in loop colostomy group.
Conclusion: Primary resection with anastomosis in obstructed metastatic CRC did not delay the waiting time for conversion chemotherapy, compared with loop colostomy or Hartmann’s procedure.
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บทความที่ส่งมาลงพิมพ์ต้องไม่เคยพิมพ์หรือกำลังได้รับการพิจารณาตีพิมพ์ในวารสารอื่น เนื้อหาในบทความต้องเป็นผลงานของผู้นิพนธ์เอง ไม่ได้ลอกเลียนหรือตัดทอนจากบทความอื่น โดยไม่ได้รับอนุญาตหรือไม่ได้อ้างอิงอย่างเหมาะสม การแก้ไขหรือให้ข้อมูลเพิ่มเติมแก่กองบรรณาธิการ จะต้องเสร็จสิ้นเป็นที่เรียบร้อยก่อนจะได้รับพิจารณาตีพิมพ์ และบทความที่ตีพิมพ์แล้วเป็นสมบัติ ของลำปางเวชสาร
References
Lohsiriwat V, Chaisomboon N, Pattana-Arun J. Current colorectal cancer in Thailand. Ann Coloproctol 2020;36(2):78−82.
Biondo S, Martí-Ragué J, Kreisler E, Parés D, Martín A, Navarro M, et al. A prospective study of outcomes of emergency and elective surgeries for complicated colonic cancer. Am J Surg. 2005;189(4):377−83.
McGregor JR, O’Dwyer PJ. The surgical management of obstruction and perforation of the left colon. Surg Gynecol Obstet. 1993;177(2):203−8.
McArdle CS, Hole DJ. Emergency presentation of colorectal cancer is associated with poor 5-year survival. Br J Surg. 2004;91(5):605–9.
Kızıltan R, Yılmaz Ö, Aras A, Çelik S, Kotan Ç. Factors affecting mortality in emergency surgery in cases of complicated colorectal cancer. Med Glas (Zenica). 2016;13(1):62−7.
Alvarez JA, Baldonedo RF, Bear IG, Truán N, Pire G, Alvarez P. Presentation, treatment, and multivariate analysis of risk factors for obstructive and perforative colorectal carcinoma. Am J Surg. 2005;190(3):376−82.
Benson AB 3rd, Venook AP, Bekaii-Saab T, Chan E, Chen YJ, Cooper HS, et al. Colon cancer, version 3.2014. J Natl Compr Canc Netw. 2014;12(7):1028−59.
National Cancer Institute of Thailand. Hospitalbased cancer registry 2017. Bangkok: Pronsup Printing; 2017.
Zorcolo L, Covotta L, Carlomagno N, Bartolo DC. Safety of primary anastomosis in emergency colo-rectal surgery. Colorectal Dis. 2003;5(3):262−9.
Villar JM, Martinez AP, Villegas MT, Muffak K, Mansilla A, Garrote D, et al. Surgical options for malignant left-sided colonic obstruction. Surg Today. 2005;35(4):275−81.
Biondo S, Parés D, Frago R, Martí-Ragué J, Kreisler E, De Oca J, et al. Large bowel obstruction: predictive factors for postoperative mortality. Dis Colon Rectum. 2004;47(11):1889−97.
Meyer F, Marusch F, Coch A, Meyer L, Fuhrer S, Kockerling F, et al. Emergency operation in carcinomas of the left colon: value of Hartmann’s procedure. Tech Coloproctol. 2004;8 Suppl 1:s226−9.
Desai DC, Brennan EJ, Reilly JF, Smink RD Jr. The utility of the Hartmann procedure. Am J Surg. 1998;175(2):152−4.
Tsoulfas G, Pramateftakis MG. Management of rectal cancer and liver metastatic disease: which comes first?. Int J Surg Oncol. 2012;2012:196908.
Abdalla EK, Bauer TW, Chun YS, D’Angelica M, Kooby DA, Jarnagin WR. Locoregional surgical and interventional therapies for advanced colorectal cancer liver metastases: expert consensus statements. HPB (Oxford). 2013;15(2):119−30.
Tzeng CW, Aloia TA. Colorectal liver metastases. J Gastrointest Surg 2013;17(1):195−201.
Gustavsson B, Carlsson G, Machover D, Petrelli N, Roth A, Schmoll HJ, et al. A review of the evolution of systemic chemotherapy in the management of colorectal cancer. Clin Colorectal Cancer. 2015;14(1):1−10.