Cancer Res Treat.  2019 Apr;51(2):474-482. 10.4143/crt.2018.059.

Long-term Outcomes of One Stage Surgery Using Transanal Colorectal Tube for Acute Colorectal Obstruction of Stage II/III Distal Colon Cancer

• Okuda Y
• Yamada T
• Hirata Y
• Shimura T
• Yamaguchi
• Sakamoto E
• Sobue S
• Nakazawa T
• Kataoka H
• Joh T

• KMID: 2464394
• DOI: http://doi.org/10.4143/crt.2018.059

Abstract

PURPOSE
Since oncological outcomes of transanal colorectal tube (TCT) placement, an endoscopic treatment for colorectal cancer (CRC) with acute colorectal obstruction (ACO), remain unknown, this study analyzed long-term outcomes of TCT placement for stage II/III CRC with ACO.
MATERIALS AND METHODS
Data were retrospectively reviewed from consecutive patients with distal stage II/III CRC who underwent surgery between January 2007 and December 2011 at two Japanese hospitals. One hospital conducted emergency surgery and the other performed TCT placement as the standard treatment for all CRCs with ACO. Propensity score (PS) matching was used to adjust baseline characteristics between two groups.
RESULTS
Among 754 patients with distal stage II/III CRC, 680 did not have ACO (non-ACO group) and 74 had ACO (ACO group). The PS matching between both hospitals identified 234 pairs in the non-ACO group and 23 pairs in the ACO group. In the non-ACO group, the surgical quality was equivalent between the two institutions, with no significant differences in overall survival (OS) and disease-free survival (DFS). In the ACO group, the rate of primary resection/anastomosis was higher in the TCT group than in the surgery group (87.0% vs. 26.1%, p < 0.001). No significant differences were noted between the surgery and the TCT groups in OS (5-year OS, 61.9% vs. 51.5%; p=0.490) and DFS (5-year DFS, 45.9% vs. 38.3%; p=0.658).
CONCLUSION
TCT placement can achieve similar long-term outcomes to emergency surgery, with a high rate of primary resection/anastomosis for distal stage II/III colon cancer with ACO.

Keyword

Acute colorectal obstruction; Bridge to surgery; Colorectal neoplasms; Emergency surgery; Transanal colorectal tube

MeSH Terms

Asian Continental Ancestry Group
Colon*
Colonic Neoplasms*
Colorectal Neoplasms
Disease-Free Survival
Emergencies
Humans
Propensity Score
Retrospective Studies

Figure

• 

  Fig. 1. Consort diagram. The Kasugai Municipal Hospital, Kasugai, Japan (K hospital) applied emergency surgery and the Nagoya Daini Red Cross Hospital, Nagoya, Japan (R hospital) applied transanal colorectal tube (TCT) as the standard treatment for colorectal cancer (CRC) with acute colorectal obstruction (ACO). A-colon, ascending colon.

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  Fig. 2. Overall survival (OS) (A) and disease-free survival (DFS) (B) for stage II/III colorectal cancer without acute colorectal obstruction. K hospital, Kasugai Municipal Hospital, Kasugai, Japan; R hospital, Nagoya Daini Red Cross Hospital, Nagoya, Japan.

• 

  Fig. 3. Overall survival (OS) (A) and disease-free survival (DFS) (B) for stage II/III colorectal cancer with acute colorectal obstruction. Surgery group comprised patients with emergency surgery at Kasugai Municipal Hospital, Kasugai, Japan (K hospital) and transanal colorectal tube (TCT) group did patients with TCT at Nagoya Daini Red Cross Hospital, Nagoya, Japan (R hospital).

Reference

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