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Long-term outcome after one-stage surgery without preoperative decompression for stage II/III malignant colorectal obstruction: a propensity score-matched analysis.

Abstract：

PURPOSE:Whether malignant colorectal obstruction (MCO) after one-stage curative surgery without preoperative decompression has a poor prognosis remains unclear. We assessed long-term outcomes of one-stage surgery without preoperative decompression for stage II/III MCO. METHODS:We retrospectively enrolled patients with stage II/III colorectal cancer (CRC) between April 2011 and December 2017. Propensity score-matched (PSM) analysis was used to reduce the possibility of selection bias. RESULTS:In total, 464 stage II/III CRC patients were identified, of which 145 (31%) had obstruction (MCO group) and 319 (69%) did not (non-MCO group). In the MCO group, 59 (40.7%) had emergency MCO (E-MCO) and 86 (59.3%) had semi-emergency MCO (SE-MCO). The median follow-up was 37.0 (range 0-86.5) months. The tumor was deeper and larger, and serum carcinoembryonic antigen level was higher (p < 0.001, respectively) in the MCO group (including E-MCO and SE-MCO). Venous invasion-positivity rate was significantly higher (MCO and SE-MCO only, p = 0.003 and 0.009, respectively) than that in the non-MCO group. Laparoscopic surgery rate was significantly lower (MCO and E-MCO only, p < 0.001) than that in the non-MCO group. Before PSM, disease-free survival (DFS) of the SE-MCO patients was worse than that of the non-MCO patients (p = 0.046). After PSM, DFS was not significantly different between the non-MCO and MCO, E-MCO, and SE-MCO groups (p = 0.619, 0.091, and 0.308, respectively). CONCLUSIONS:Long-term prognosis in patients with stage II/III MCO after one-stage surgery without preoperative decompression was similar to that in patients without MCO.

journal_name

Int J Colorectal Dis

journal_title

International journal of colorectal disease

authors

Takeyama H,Ikeda K,Danno K,Nishigaki T,Yamashita M,Taniguchi H,Oka Y

doi

10.1007/s00384-019-03413-z

subject

Has Abstract

pub_date

2019-11-01 00:00:00

pages

1933-1943

issue

eissn

0179-1958

issn

1432-1262

pii

10.1007/s00384-019-03413-z

journal_volume

pub_type

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Long-term outcome after one-stage surgery without preoperative decompression for stage II/III malignant colorectal obstruction: a propensity score-matched analysis.