Evolution in the Management of Left-Sided Obstructive Colon Cancer in the Netherlands During a 9-Year Period.

IF 14.8 2区 医学 Q1 ONCOLOGY Journal of the National Comprehensive Cancer Network Pub Date : 2024-12-01 DOI:10.6004/jnccn.2024.7057
Julie M L Sijmons, Jan Willem T Dekker, Jurriaan B Tuynman, Femke J Amelung, Esther C J Consten, Henderik L van Westreenen, Johannes H W de Wilt, Rob A E M Tollenaar, Pieter J Tanis
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Abstract

Background: There is growing evidence that bridge to surgery with stent or decompressing stoma for left-sided obstructive colon cancer (LSOCC) is better than emergency resection (ER), especially in elderly patients (age ≥70 years). This was already incorporated in Dutch guideline recommendations in 2014. The aim of this study was to evaluate time trends and interhospital variability in treatment approaches for LSOCC, and to compare short-term outcomes between approaches.

Patients and methods: Data of patients undergoing resection for LSOCC between 2012 and 2020 were extracted from the Dutch ColoRectal Audit.

Results: A total of 4,535 patients were included (3,155 ER, 573 semielective resection [SER], 807 resection after stent or stoma [RSS]). A decrease in ER over time was observed (79.7% in 2012-2014, 68.8% in 2015-2017, and 54.7% in 2018-2020) in favor of RSS (9.2%, 17.9%, and 31.2%, respectively). Compared with SER and RSS, ER was associated with higher 30-day mortality (6.2% ER, 2.8% SER, and 1.0% RSS; P<.001) and complication rates (45.4%, 31.2%, 31.5%, respectively; P<.001). There were still 19 hospitals with >75% ER in 2018-2020. For hospitals with >75% ER, mortality was significantly higher compared with hospitals mainly performing SER and RSS (5.6% vs 4.2%; P=.038). The proportion of ER in patients (age ≥70 years) decreased from 80.7% in 2012-2014 to 54.3% in 2018-2020 (P<.001). Mortality in patients aged ≥70 years was significantly lower after RSS than after ER (1.6% vs 9.5%; P<.001).

Conclusions: A significant decrease in ER for LSOCC at a national level was observed, although with a variable degree of adherence to revised guidelines among hospitals. The high risk of mortality after ER, especially in elderly patients, strongly supports the guideline recommendations to perform bridge to surgery in these patients.

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背景:越来越多的证据表明,左侧梗阻性结肠癌(LSOCC)的支架或减压造口手术桥接优于急诊切除术(ER),尤其是对于老年患者(年龄≥70 岁)。这一点已于 2014 年纳入荷兰指南建议。本研究旨在评估LSOCC治疗方法的时间趋势和医院间差异,并比较不同方法的短期疗效:从荷兰结肠直肠审计(Dutch ColoRectal Audit)中提取了2012年至2020年间接受LSOCC切除术的患者数据:结果:共纳入 4535 例患者(3155 例 ER、573 例半选择性切除术 [SER]、807 例支架或造口术后切除术 [RSS])。随着时间的推移,观察到 ER 有所下降(2012-2014 年为 79.7%,2015-2017 年为 68.8%,2018-2020 年为 54.7%),而 RSS 则有所下降(分别为 9.2%、17.9% 和 31.2%)。与 SER 和 RSS 相比,ER 与更高的 30 天死亡率相关(2018-2020 年,ER 为 6.2%,SER 为 2.8%,RSS 为 1.0%;P75% ER。与主要实施 SER 和 RSS 的医院相比,ER>75% 的医院死亡率明显更高(5.6% vs 4.2%;P=.038)。患者(年龄≥70 岁)的 ER 比例从 2012-2014 年的 80.7% 降至 2018-2020 年的 54.3%(PConclusions:尽管各医院对修订指南的遵守程度不一,但在全国范围内观察到 LSOCC 的急诊率明显下降。急诊室手术后的死亡风险很高,尤其是老年患者,这有力地支持了指南中关于对这些患者进行手术桥接的建议。
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来源期刊
CiteScore
20.20
自引率
0.00%
发文量
388
审稿时长
4-8 weeks
期刊介绍: JNCCN—Journal of the National Comprehensive Cancer Network is a peer-reviewed medical journal read by over 25,000 oncologists and cancer care professionals nationwide. This indexed publication delivers the latest insights into best clinical practices, oncology health services research, and translational medicine. Notably, JNCCN provides updates on the NCCN Clinical Practice Guidelines in Oncology® (NCCN Guidelines®), review articles elaborating on guideline recommendations, health services research, and case reports that spotlight molecular insights in patient care. Guided by its vision, JNCCN seeks to advance the mission of NCCN by serving as the primary resource for information on NCCN Guidelines®, innovation in translational medicine, and scientific studies related to oncology health services research. This encompasses quality care and value, bioethics, comparative and cost effectiveness, public policy, and interventional research on supportive care and survivorship. JNCCN boasts indexing by prominent databases such as MEDLINE/PubMed, Chemical Abstracts, Embase, EmCare, and Scopus, reinforcing its standing as a reputable source for comprehensive information in the field of oncology.
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