Background/Aims: The prematurely closed Stent-In II trial in patients with left-sided obstructive colon cancer may have influenced clinical decision making in The Netherlands. The aim of this study was to evaluate treatment of left-sided malignant colon obstruction at a population level since then. Methods: Short-term outcomes of all patients who underwent resection for left-sided obstructive colon cancer between 2009 and 2012 were assessed based on a prospective national registry. Results: In total, 1,816 evaluable patients were included; acute resection was performed in 1,485 (81.8%), and endoscopic stent or decompressing stoma followed by resection in 196 (10.8%) and 135 (7.4%), respectively. The use of endoscopic stenting significantly decreased from 18% (2009) to 6% (2012). Overall 30-day or in-hospital mortality rate was 6.9, 5.6, and 3.7%, respectively (p = 0.107). Mortality rate after acute resection was 2.9% in patients >70 years, but mortality rates up to 32.2% were observed in high-risk elderly patients. Conclusion: Acute resection as first choice treatment seems justified for patients >70 years of age given a mortality rate of 3%. For the elderly frail patients, mortality rates over 30% after acute resection stress the need for alternative treatment strategies.

1.
Biondo S, Parés D, Frago R, Martí-Ragué J, Kreisler E, De Oca J, Jaurrieta E: Large bowel obstruction: predictive factors for postoperative mortality. Dis Colon Rectum 2004;47:1889-1897.
2.
Panis Y, Maggiori L, Caranhac G, Bretagnol F, Vicaut E: Mortality after colorectal cancer surgery: a French survey of more than 84,000 patients. Ann Surg 2011;254:738-743.
3.
Deans GT, Krukowski ZH, Irwin ST: Malignant obstruction of the left colon. Br J Surg 1994;81:1270-1276.
4.
Tilney HS, Lovegrove RE, Purkayastha S, Sains PS, Weston-Petrides GK, Darzi AW, Tekkis PP, Heriot AG: Comparison of colonic stenting and open surgery for malignant large bowel obstruction. Surg Endosc 2007;21:225-233.
5.
Jiang JK, Lan YT, Lin TC, Chen WS, Yang SH, Wang HS, Chang SC, Lin JK: Primary vs. delayed resection for obstructive left-sided colorectal cancer: impact of surgery on patient outcome. Dis Colon Rectum 2008;51:306-311.
6.
van Hooft JE, Bemelman WA, Oldenburg B, Marinelli AW, Lutke Holzik MF, Grubben MJ, Sprangers MA, Dijkgraaf MG, Fockens P: Colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a multicentre randomised trial. Lancet Oncol 2011;12:344-352.
7.
Van Leersum NJ, Snijders HS, Henneman D, Kolfschoten NE, Gooiker GA, ten Berge MG, Eddes EH, Wouters MW, Tollenaar RA, Bemelman WA, van Dam RM, Elferink MA, Karsten TM, van Krieken JH, Lemmens VE, Rutten HJ, Manusama ER, van de Velde CJ, Meijerink WJ, Wiggers T, van der Harst E, Dekker JW, Boerma D: The Dutch surgical colorectal audit. Eur J Surg Oncol 2013;39:1063-1070.
8.
Kronborg O: Acute obstruction from tumour in the left colon without spread. A randomized trial of emergency colostomy versus resection. Int J Colorectal Dis 1995;10:1-5.
9.
Smothers L, Hynan L, Fleming J, Turnage R, Simmang C, Anthony T: Emergency surgery for colon carcinoma. Dis Colon Rectum 2003;46:24-30.
10.
Tekkis PP, Kinsman R, Thompson MR, Stamatakis JD: The association of coloproctology of great Britain and Ireland study of large bowel obstruction caused by colorectal cancer. Ann Surg 2004;240:76-81.
11.
Kube R, Granowski D, Stübs P, Mroczkowski P, Ptok H, Schmidt U, Gastinger I, Lippert H: Surgical practices for malignant left colonic obstruction in Germany. Eur J Surg Oncol 2010;36:65-71.
12.
Gorissen KJ, Tuynman JB, Fryer E, Wang L, Uberoi R, Jones OM, Cunningham C, Lindsey I: Local recurrence after stenting for obstructing left-sided colonic cancer. Br J Surg 2013;100:1805-1809.
13.
Sabbagh C, Browet F, Diouf M, Cosse C, Brehant O, Bartoli E, Mauvais F, Chauffert B, Dupas JL, Nguyen-Khac E, Regimbeau JM: Is stenting as ‘a bridge to surgery' an oncologically safe strategy for the management of acute, left-sided, malignant, colonic obstruction? A comparative study with a propensity score analysis. Ann Surg 2013;258:107-115.
14.
Tan CJ, Dasari BV, Gardiner K: Systematic review and meta-analysis of randomized clinical trials of self-expanding metallic stents as a bridge to surgery versus emergency surgery for malignant left-sided large bowel obstruction. Br J Surg 2012;99:469-476.
15.
Ye GY, Cui Z, Chen L, Zhong M: Colonic stenting vs emergent surgery for acute left-sided malignant colonic obstruction: a systematic review and meta-analysis. World J Gastroenterol 2012;18:5608-5615.
16.
Cirocchi R, Farinella E, Trastulli S, Desiderio J, Listorti C, Boselli C, Parisi A, Noya G, Sagar J: Safety and efficacy of endoscopic colonic stenting as a bridge to surgery in the management of intestinal obstruction due to left colon and rectal cancer: a systematic review and meta-analysis. Surg Oncol 2013;22:14-21.
17.
Sagar J: Colorectal stents for the management of malignant colonic obstructions. Cochrane Database Syst Rev 2011;11:CD007378.
18.
Govindarajan A, Naimark D, Coburn NG, Smith AJ, Law CH: Use of colonic stents in emergent malignant left colonic obstruction: a Markov chain Monte Carlo decision analysis. Dis Colon Rectum 2007;50:1811-1824.
19.
Foxtrot Collaborative Group: Feasibility of preoperative chemotherapy for locally advanced, operable colon cancer: the pilot phase of a randomised controlled trial. Lancet Oncol 2012;13:1152-1160.
20.
Manes G, de Bellis M, Fuccio L, Repici A, Masci E, Ardizzone S, Mangiavillano B, Carlino A, Rossi GB, Occhipinti P, Cennamo V: Endoscopic palliation in patients with incurable malignant colorectal obstruction by means of self-expanding metal stent: analysis of results and predictors of outcomes in a large multicenter series. Arch Surg 2011;146:1157-1162.
21.
Small AJ, Coelho-Prabhu N, Baron TH: Endoscopic placement of self-expandable metal stents for malignant colonic obstruction: long-term outcomes and complication factors. Gastrointest Endosc 2010;71:560-572.
22.
Fiori E, Lamazza A, Schillaci A, Femia S, Demasi E, Decesare A, Sterpetti AV: Palliative management for patients with subacute obstruction and stage IV unresectable rectosigmoid cancer: colostomy versus endoscopic stenting: final results of a prospective randomized trial. Am J Surg 2012;204:321-326.
23.
Karoui M, Charachon A, Delbaldo C, Loriau J, Laurent A, Sobhani I, Tran Van Nhieu J, Delchier JC, Fagniez PL, Piedbois P, Cherqui D: Stents for palliation of obstructive metastatic colon cancer: impact on management and chemotherapy administration. Arch Surg 2007;142:619-623.
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