Changes in Management of Left-Sided Obstructive Colon Cancer: National Practice and Guideline Implementation

Dutch Snapshot Res Grp; Esther Catharina Josephina Consten

doi:10.6004/jnccn.2019.7326

Changes in Management of Left-Sided Obstructive Colon Cancer: National Practice and Guideline Implementation

Dutch Snapshot Res Grp, Esther Catharina Josephina Consten

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Abstract

Background: Previous analysis of Dutch practice in treatment of left-sided obstructive colon cancer (LSOCC) until 2012 showed that emergency resection (ER) was preferred, with high mortality in patients aged >= 70 years. Consequently, Dutch and European guidelines in 2014 recommended a bridge to surgery (BTS) with either self-expandable metal stent (SEMS) or decompressing stoma (DS) in high-risk patients. The implementation and effects of these guidelines have not yet been evaluated. Therefore, our aim was to perform an in-depth update of national practice concerning curative treatment of LSOCC, including an evaluation of guideline implementation. Patients and Methods: This multicenter cohort study was conducted in 75 of 77 hospitals in the Netherlands. We included data on patients who underwent curative resection of LSOCC in 2009 through 2016 obtained from the Dutch ColoRectal Audit. Additional data were retrospectively collected. Results: A total of 2,587 patients were included (2,013 ER, 345 DS, and 229 SEMS). A trend was observed in reversal of ER (decrease from 86.2% to 69.6%) and SEMS (increase from 1.3% to 7.8%) after 2014, with an ongoing increase in DS (from 5.2% in 2009 to 22.7% in 2016). DS after 2014 was associated with more laparoscopic resections (66.0% vs 35.5%; P

Original language	English
Pages (from-to)	1512-1520
Number of pages	14
Journal	Journal of the national comprehensive cancer network
Volume	17
Issue number	12
DOIs	https://doi.org/10.6004/jnccn.2019.7326
Publication status	Published - Dec-2019

Keywords

LARGE-BOWEL OBSTRUCTION
SURGERY
RESECTION
COLOSTOMY
OUTCOMES

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@article{cf8e87604bb44eee8d26cf08632405c4,

title = "Changes in Management of Left-Sided Obstructive Colon Cancer: National Practice and Guideline Implementation",

abstract = "Background: Previous analysis of Dutch practice in treatment of left-sided obstructive colon cancer (LSOCC) until 2012 showed that emergency resection (ER) was preferred, with high mortality in patients aged >= 70 years. Consequently, Dutch and European guidelines in 2014 recommended a bridge to surgery (BTS) with either self-expandable metal stent (SEMS) or decompressing stoma (DS) in high-risk patients. The implementation and effects of these guidelines have not yet been evaluated. Therefore, our aim was to perform an in-depth update of national practice concerning curative treatment of LSOCC, including an evaluation of guideline implementation. Patients and Methods: This multicenter cohort study was conducted in 75 of 77 hospitals in the Netherlands. We included data on patients who underwent curative resection of LSOCC in 2009 through 2016 obtained from the Dutch ColoRectal Audit. Additional data were retrospectively collected. Results: A total of 2,587 patients were included (2,013 ER, 345 DS, and 229 SEMS). A trend was observed in reversal of ER (decrease from 86.2% to 69.6%) and SEMS (increase from 1.3% to 7.8%) after 2014, with an ongoing increase in DS (from 5.2% in 2009 to 22.7% in 2016). DS after 2014 was associated with more laparoscopic resections (66.0% vs 35.5%; P",

keywords = "LARGE-BOWEL OBSTRUCTION, SURGERY, RESECTION, COLOSTOMY, OUTCOMES",

author = "{Dutch Snapshot Res Grp} and Consten, {Esther Catharina Josephina} and Argillander, {T. E.} and Bakker, {I. S.} and Beets, {G. L.} and {van den Berg}, A. and Blom, {R. L. G. M.} and Boerma, {E. G.} and Bouwman, {J. E.} and Burghgraef, {T. A.} and M. Dam and Dekker, {J. W. T.} and {van Essen}, {J. A.} and Furnee, {E. J. B.} and {de Haas}, {J. W. A.} and Hamminga, {J. T. H.} and K. Havenga and {van den Hengel}, B. and {van der Harst}, E. and J. Heemskerk and Heikens, {J. T.} and B. Inberg and Janssen, {T. L.} and {de Jong}, {W. J.} and Jongen, {A. C. H. M.} and A. Kamman and Klaase, {J. M.} and W. Kelder and Kortekaas, {R. T. J.} and Lange, {J. F.} and G. Lo and Menon, {A. G.} and Nieboer, {M. J.} and P. Oomen and {van Oorschot}, N. and Peeters, {K. C. M. J.} and {de Ruijter}, {W. M. J.} and Rutten, {H. J. T.} and {van der Sluis}, M. and {van der Sluis}, P. and D. Smit and Smits, {A. B.} and Sonneveld, {D. J. A.} and Struijs, {M. C.} and Talsma, {A. K.} and {van Veen}, {M. J. F.} and Veltkamp, {S. C.} and {van de Ven}, {A. W. H.} and T. Visser and {de Vries}, {H. S.} and M. Westerterp and Zwols, {T. L. R.}",

year = "2019",

month = dec,

doi = "10.6004/jnccn.2019.7326",

language = "English",

volume = "17",

pages = "1512--1520",

journal = "Journal of the national comprehensive cancer network",

issn = "1540-1405",

publisher = "HARBORSIDE PRESS",

number = "12",

}

TY - JOUR

T1 - Changes in Management of Left-Sided Obstructive Colon Cancer

T2 - National Practice and Guideline Implementation

AU - Dutch Snapshot Res Grp

AU - Consten, Esther Catharina Josephina

AU - Argillander, T. E.

AU - Bakker, I. S.

AU - Beets, G. L.

AU - van den Berg, A.

AU - Blom, R. L. G. M.

AU - Boerma, E. G.

AU - Bouwman, J. E.

AU - Burghgraef, T. A.

AU - Dam, M.

AU - Dekker, J. W. T.

AU - van Essen, J. A.

AU - Furnee, E. J. B.

AU - de Haas, J. W. A.

AU - Hamminga, J. T. H.

AU - Havenga, K.

AU - van den Hengel, B.

AU - van der Harst, E.

AU - Heemskerk, J.

AU - Heikens, J. T.

AU - Inberg, B.

AU - Janssen, T. L.

AU - de Jong, W. J.

AU - Jongen, A. C. H. M.

AU - Kamman, A.

AU - Klaase, J. M.

AU - Kelder, W.

AU - Kortekaas, R. T. J.

AU - Lange, J. F.

AU - Lo, G.

AU - Menon, A. G.

AU - Nieboer, M. J.

AU - Oomen, P.

AU - van Oorschot, N.

AU - Peeters, K. C. M. J.

AU - de Ruijter, W. M. J.

AU - Rutten, H. J. T.

AU - van der Sluis, M.

AU - van der Sluis, P.

AU - Smit, D.

AU - Smits, A. B.

AU - Sonneveld, D. J. A.

AU - Struijs, M. C.

AU - Talsma, A. K.

AU - van Veen, M. J. F.

AU - Veltkamp, S. C.

AU - van de Ven, A. W. H.

AU - Visser, T.

AU - de Vries, H. S.

AU - Westerterp, M.

AU - Zwols, T. L. R.

PY - 2019/12

Y1 - 2019/12

N2 - Background: Previous analysis of Dutch practice in treatment of left-sided obstructive colon cancer (LSOCC) until 2012 showed that emergency resection (ER) was preferred, with high mortality in patients aged >= 70 years. Consequently, Dutch and European guidelines in 2014 recommended a bridge to surgery (BTS) with either self-expandable metal stent (SEMS) or decompressing stoma (DS) in high-risk patients. The implementation and effects of these guidelines have not yet been evaluated. Therefore, our aim was to perform an in-depth update of national practice concerning curative treatment of LSOCC, including an evaluation of guideline implementation. Patients and Methods: This multicenter cohort study was conducted in 75 of 77 hospitals in the Netherlands. We included data on patients who underwent curative resection of LSOCC in 2009 through 2016 obtained from the Dutch ColoRectal Audit. Additional data were retrospectively collected. Results: A total of 2,587 patients were included (2,013 ER, 345 DS, and 229 SEMS). A trend was observed in reversal of ER (decrease from 86.2% to 69.6%) and SEMS (increase from 1.3% to 7.8%) after 2014, with an ongoing increase in DS (from 5.2% in 2009 to 22.7% in 2016). DS after 2014 was associated with more laparoscopic resections (66.0% vs 35.5%; P

AB - Background: Previous analysis of Dutch practice in treatment of left-sided obstructive colon cancer (LSOCC) until 2012 showed that emergency resection (ER) was preferred, with high mortality in patients aged >= 70 years. Consequently, Dutch and European guidelines in 2014 recommended a bridge to surgery (BTS) with either self-expandable metal stent (SEMS) or decompressing stoma (DS) in high-risk patients. The implementation and effects of these guidelines have not yet been evaluated. Therefore, our aim was to perform an in-depth update of national practice concerning curative treatment of LSOCC, including an evaluation of guideline implementation. Patients and Methods: This multicenter cohort study was conducted in 75 of 77 hospitals in the Netherlands. We included data on patients who underwent curative resection of LSOCC in 2009 through 2016 obtained from the Dutch ColoRectal Audit. Additional data were retrospectively collected. Results: A total of 2,587 patients were included (2,013 ER, 345 DS, and 229 SEMS). A trend was observed in reversal of ER (decrease from 86.2% to 69.6%) and SEMS (increase from 1.3% to 7.8%) after 2014, with an ongoing increase in DS (from 5.2% in 2009 to 22.7% in 2016). DS after 2014 was associated with more laparoscopic resections (66.0% vs 35.5%; P

KW - LARGE-BOWEL OBSTRUCTION

KW - SURGERY

KW - RESECTION

KW - COLOSTOMY

KW - OUTCOMES

U2 - 10.6004/jnccn.2019.7326

DO - 10.6004/jnccn.2019.7326

M3 - Article

SN - 1540-1405

VL - 17

SP - 1512

EP - 1520

JO - Journal of the national comprehensive cancer network

JF - Journal of the national comprehensive cancer network

IS - 12

ER -

Changes in Management of Left-Sided Obstructive Colon Cancer: National Practice and Guideline Implementation

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Keywords

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