A Systematic Review Comparing Emergency Resection and Staged Treatment for Curable Obstructing Right-Sided Colon Cancer
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REVIEW ARTICLE – GASTROINTESTINAL ONCOLOGY
A Systematic Review Comparing Emergency Resection and Staged Treatment for Curable Obstructing Right-Sided Colon Cancer Jeske R. E. Boeding, MD1,2 , Winesh Ramphal, MD1, Arjen M. Rijken, MD, PhD1, Rogier M. P. H. Crolla, MD1, Cornelis Verhoef, MD, PhD2, Paul D. Gobardhan, MD, PhD1, and Jennifer M. J. Schreinemakers, MD, PhD1 1
Department of Surgery, Amphia Hospital, Breda, The Netherlands; 2Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
ABSTRACT Background. Treatment for obstructing colon cancer (OCC) is controversial because the outcome of acute resection is less favorable than for patients without obstruction. Few studies have investigated curable rightsided OCC, and patients with OCC usually undergo acute resection. This study aimed to better understand the outcome and best management of potentially curable rightsided OCC. Methods. A systematic review of studies was performed with a focus on differences in mortality and morbidity between emergency resection and staged treatment for patients with potentially curable right-sided OCC. In March 2019, the study searched Embase, Medline, Web of Science, Cochrane, and Google scholar databases according to PRISMA guidelines using search terms related to ‘‘colon tumour,’’ ‘‘stenosis or obstruction and surgery,’’ and ‘‘decompression or stents.’’ All English-language studies reporting emergency or staged treatment for potentially curable right-sided OCC were included in the review. Emergency resection and staged resection were compared for mortality, morbidity, complications, and survival. Results. Nine studies were found to be eligible and comprised 600 patients treated with curative intent for their right-sided OCC by emergency resection or staged
Ó Society of Surgical Oncology 2020 First Received: 24 March 2020 Accepted: 31 August 2020 J. R. E. Boeding, MD e-mail: [email protected]
resection. The mean overall complication rate was 42% (range 19–54%) after emergency resection, and 30% (range 7–44%) after staged treatment. The average mortality rate was 7.2% (range 0–14.5%) after emergency resection and 1.2% (range 0–6.3%) after staged treatment. The 5-year disease-free and overall survival rates were comparable for the two treatments. Conclusions. The patients who received staged treatment for right-sided OCC had lower mortality rates, fewer complications, and fewer anastomotic leaks and stoma creations than the patients who had emergency resection.
Intestinal obstruction is a presenting symptom for 10–28% of patients with colon cancer.1–4 Patients with obstructing colon cancer (OCC) often present with a deteriorating physical condition and significant unintentional weight loss due to a catabolic state with muscle wasting. The symptoms associated with obstruction-like nausea, abdominal pain, and vomiting often lead to inherent and altered oral intake and ultimately to no oral intake at all. Sometimes obstruction is even associated with complications such as perforation or seps
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