Evolution in the Management of Left-Sided Obstructive Colon Cancer in the Netherlands During a 9-Year Period
Dutch Institute for Clinical Auditing, Leiden, the Netherlands
Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, the Netherlands
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Department of Surgery, Meander Medical Centre, Amersfoort, the Netherlands
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Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
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Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, the Netherlands
Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC, Rotterdam, the Netherlands
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Background: There is growing evidence that bridge to surgery with stent or decompressing stoma for left-sided obstructive colon cancer (LSOCC) is better than emergency resection (ER), especially in elderly patients (age ≥70 years). This was already incorporated in Dutch guideline recommendations in 2014. The aim of this study was to evaluate time trends and interhospital variability in treatment approaches for LSOCC, and to compare short-term outcomes between approaches. Patients and Methods: Data of patients undergoing resection for LSOCC between 2012 and 2020 were extracted from the Dutch ColoRectal Audit. Results: A total of 4,535 patients were included (3,155 ER, 573 semielective resection [SER], 807 resection after stent or stoma [RSS]). A decrease in ER over time was observed (79.7% in 2012–2014, 68.8% in 2015–2017, and 54.7% in 2018–2020) in favor of RSS (9.2%, 17.9%, and 31.2%, respectively). Compared with SER and RSS, ER was associated with higher 30-day mortality (6.2% ER, 2.8% SER, and 1.0% RSS; P<.001) and complication rates (45.4%, 31.2%, 31.5%, respectively; P<.001). There were still 19 hospitals with >75% ER in 2018–2020. For hospitals with >75% ER, mortality was significantly higher compared with hospitals mainly performing SER and RSS (5.6% vs 4.2%; P=.038). The proportion of ER in patients (age ≥70 years) decreased from 80.7% in 2012–2014 to 54.3% in 2018–2020 (P<.001). Mortality in patients aged ≥70 years was significantly lower after RSS than after ER (1.6% vs 9.5%; P<.001). Conclusions: A significant decrease in ER for LSOCC at a national level was observed, although with a variable degree of adherence to revised guidelines among hospitals. The high risk of mortality after ER, especially in elderly patients, strongly supports the guideline recommendations to perform bridge to surgery in these patients.
Submitted August 28, 2023; final revision received June 15, 2024; accepted for publication July 11, 2024.
Author contributions: Study concept & design: Sijmons, Dekker, Tanis. Investigation: Sijmons. Data curation & formal analysis: Sijmons. Projection administration: Sijmons. Resources: Sijmons. Software: Sijmons. Validation & visualization: Sijmons. Writing—original draft: Sijmons. Review & approval of draft: All authors.
Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.
Supplementary material: Supplementary material associated with this article is available online at https://doi.org/10.6004/jnccn.2024.7057. The supplementary material has been supplied by the author(s) and appears in its originally submitted form. It has not been edited or vetted by JNCCN. All contents and opinions are solely those of the author. Any comments or questions related to the supplementary materials should be directed to the corresponding author.
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