Postponing surgery to optimise patients with acute right-sided obstructing colon cancer - A pilot study.

Autor: Boeding JRE; Department of Surgery, Amphia Hospital, Breda, the Netherlands; Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands. Electronic address: jeskeboeding@gmail.com., Cuperus IE; Department of Surgery, Amphia Hospital, Breda, the Netherlands., Rijken AM; Department of Surgery, Amphia Hospital, Breda, the Netherlands., Crolla RMPH; Department of Surgery, Amphia Hospital, Breda, the Netherlands., Verhoef C; Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands., Gobardhan PD; Department of Surgery, Amphia Hospital, Breda, the Netherlands., Schreinemakers JMJ; Department of Surgery, Amphia Hospital, Breda, the Netherlands.
Jazyk: angličtina
Zdroj: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology [Eur J Surg Oncol] 2023 Sep; Vol. 49 (9), pp. 106906. Date of Electronic Publication: 2023 Apr 09.
DOI: 10.1016/j.ejso.2023.04.005
Abstrakt: Background: Right-sided obstructing colon cancer is most often treated with acute resection. Recent studies on right-sided obstructing colon cancer report higher mortality and morbidity rates than those in patients without obstruction. The aim of this study is to retrospectively analyse whether it is possible to optimise the health condition of patients with acute right-sided obstructing colon cancer, prior to surgery, and whether this improves postoperative outcomes.
Method: All consecutive patients with high suspicion of, or histologically proven, right-sided obstructing colon cancer, treated with curative intent between March 2013 and December 2019, were analysed retrospectively. Patients were divided into two groups: optimised group and non-optimised group. Pre-operative optimisation included additional nutrition, physiotherapy, and, if needed, bowel decompression.
Results: In total, 54 patients were analysed in this study. Twenty-four patients received optimisation before elective surgery, and thirty patients received emergency surgery, without optimisation. Scheduled surgery was performed after a median of eight days (IQR 7-12). Postoperative complications were found in twelve (50%) patients in the optimised group, compared to twenty-three (77%) patients in the non-optimised group (p = 0.051). Major complications were diagnosed in three (13%) patients with optimisation, compared to ten (33%) patients without optimisation (p = 0.111). Postoperative in-hospital stay, 30-day mortality, as well as primary anastomosis were comparable in both groups.
Conclusion: This pilot study suggests that pre-operative optimisation of patients with obstructing right sided colonic cancer may be feasible and safe but is associated with longer in-patient stay.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Jeske R.E. Boeding reports financial support was provided by Wetenschapsfonds Amphia.
(Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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