Predicting Mortality Within 90 Days of First Intervention in Patients with Left-Sided Obstructive Colon Cancer

Thijs A. Burghgraef; Ilsalien S. Bakker; Joyce V. Veld; Arthur R. Wijsmuller; Femke J. Amelung; Willem A. Bemelman; Frank Ter Borg; Jeanin E. Van Hooft; Peter D. Siersema; Pieter J. Tanis; Esther C.J. Consten; H. Algera; G. D. Algie; C. S. Andeweg; T. E. Argillander; M. N.N.J. Arron; K. Arts; T. H.J. Aufenacker; M. Van Basten Batenburg; A. J.N.M. Bastiaansen; G. L. Beets; A. Van Den Berg; B. Van De Beukel; R. L.G.M. Blom; B. Blomberg; E. G. Boerma; F. C. Den Boer; W. A.A. Borstlap; N. D. Bouvy; J. E. Bouwman; N. D.A. Boye; A. R.M. Brandt-Kerkhof; H. T. Bransma; A. Breijer; W. T. Van Den Broek; M. E.E. Broker; J. P.M. Burbach; E. R.J. Bruns; R. M.P.H. Crolla; M. Dam, L. Daniels; J. W.T. Dekker; A. Demirkiran; K. W. Van Dongen; S. F. Durmaz; A. Van Esch; J. A. Van Essen; P. Fockens; J. W. Foppen; E. J.B. Furnee; A. A.W. Van Geloven; M. F. Gerhards; E. A. Gorter; W. M.U. Van Grevenstein; J. Van Groningen; I. A.J. De Groot-Van Veen; H. E. Haak; J. W.A. De Haas; P. Van Hagen; E. E. Van Halsema; J. T.H. Hamminga; K. Havenga; B. Van Den Hengel; E. Van Der Harst; J. Heemskerk; J. Heeren; B. H.M. Heijnen; L. Heijnen; J. T. Heikens; M. Van Heinsbergen; D. A. Hess; N. Heuchemer; C. Hoff; W. Hogendoorn; A. P.J. Houdijk; N. Hugen; B. Inberg; T. L. Janssen; D. Jean Pierre; W. J. De Jong; A. C.H.M. Jongen; A. V. Kamman; J. M. Klaase; W. Kelder; E. F. Kelling; R. Klicks; G. W. De Klein; F. W.H. Kloppenberg; J. L.M. Konsten; L. J.E.R. Koolen; V. Kornmann; R. T.J. Kortekaas; A. Kreiter; B. Lamme; J. F. Lange; T. Lettinga; D. Lips; G. Lo; F. Logeman; Y. T. Van Loon; M. F. Lutke Holzik; C. C.M. Marres; I. Masselink; A. Mearadji; G. Meisen; A. G. Menon; J. W.S. Merkus; D. J.L.M. De Mey; H. C.J. Van Der Mijle; D. E. Moes; C. J.L. Molenaar; P. A. Neijenhuis; M. J. Nieboer; K. Nielsen; G. A.P. Nieuwenhuijzen; P. Oomen; N. Van Oorschot; K. Parry; K. C.M.J. Peeters; T. Paulides; I. Paulusma; F. B. Poelmann; S. W. Polle; P. Poortman; M. H. Raber; R. J. Renger; B. M.M. Reiber; R. Roukema; W. M.J. De Ruijter; M. J.A.M. Russchen; H. J.T. Rutten; J. Scheerhoorn; S. Scheurs; H. Schippers; V. N.E. Schuermans; H. J. Schuijt; J. C. Sierink; C. Sietses; R. Silvis; J. Van Der Slegt; G. D. Slooter; M. Van Der Sluis; P. Van Der Sluis; N. Smakman; D. Smit; A. B. Smits; T. C. Van Sprundel; D. J.A. Sonneveld; C. Steur; J. Straatman; M. C. Struijs; H. A. Swank; A. K. Talsma; M. Tenhagen; J. A. M. G. Tol; J. L. Tolenaar; L. Tseng; J. B. Tuynman; M. J.F. Van Veen; S. C. Veltkamp; A. W. H. Van De Ven; L. Verkoele; M. Vermaas; H. P. Versteegh; L. Verslijs; T. Visser; H. De Wilt; D. Van Uden; W. J. Vles; R. J. De Vos Tot Nederveen Cappel; H. S. De Vries; S. T. Van Vugt; G. Vugts; J. A. Wegdam; T. J. Weijs; B. J. Van Wely; M. Westerterp; H. L. Van Westreenen; B. Wiering; N. A.T. Wijffels; A. A. Wijkmans; L. H. Wijngaarden; M. Van De Wilt; F. Wit; E. S. Van Der Zaag; D. D.E. Zimmerman; T. L.R. Zwols

doi:10.1097/DCR.0000000000002382

Predicting Mortality Within 90 Days of First Intervention in Patients with Left-Sided Obstructive Colon Cancer

Thijs A. Burghgraef, Ilsalien S. Bakker, Joyce V. Veld, Arthur R. Wijsmuller, Femke J. Amelung, Willem A. Bemelman, Frank Ter Borg, Jeanin E. Van Hooft, Peter D. Siersema, Pieter J. Tanis, Esther C.J. Consten^*, H. Algera, G. D. Algie, C. S. Andeweg, T. E. Argillander, M. N.N.J. Arron, K. Arts, T. H.J. Aufenacker, M. Van Basten Batenburg, A. J.N.M. BastiaansenG. L. Beets, A. Van Den Berg, B. Van De Beukel, R. L.G.M. Blom, B. Blomberg, E. G. Boerma, F. C. Den Boer, W. A.A. Borstlap, N. D. Bouvy, J. E. Bouwman, N. D.A. Boye, A. R.M. Brandt-Kerkhof, H. T. Bransma, A. Breijer, W. T. Van Den Broek, M. E.E. Broker, J. P.M. Burbach, E. R.J. Bruns, R. M.P.H. Crolla, M. Dam, L. Daniels, J. W.T. Dekker, A. Demirkiran, K. W. Van Dongen, S. F. Durmaz, A. Van Esch, J. A. Van Essen, P. Fockens, J. W. Foppen, E. J.B. Furnee, A. A.W. Van Geloven, M. F. Gerhards, E. A. Gorter, W. M.U. Van Grevenstein, J. Van Groningen, I. A.J. De Groot-Van Veen, H. E. Haak, J. W.A. De Haas, P. Van Hagen, E. E. Van Halsema, J. T.H. Hamminga, K. Havenga, B. Van Den Hengel, E. Van Der Harst, J. Heemskerk, J. Heeren, B. H.M. Heijnen, L. Heijnen, J. T. Heikens, M. Van Heinsbergen, D. A. Hess, N. Heuchemer, C. Hoff, W. Hogendoorn, A. P.J. Houdijk, N. Hugen, B. Inberg, T. L. Janssen, D. Jean Pierre, W. J. De Jong, A. C.H.M. Jongen, A. V. Kamman, J. M. Klaase, W. Kelder, E. F. Kelling, R. Klicks, G. W. De Klein, F. W.H. Kloppenberg, J. L.M. Konsten, L. J.E.R. Koolen, V. Kornmann, R. T.J. Kortekaas, A. Kreiter, B. Lamme, J. F. Lange, T. Lettinga, D. Lips, G. Lo, F. Logeman, Y. T. Van Loon, M. F. Lutke Holzik, C. C.M. Marres, I. Masselink, A. Mearadji, G. Meisen, A. G. Menon, J. W.S. Merkus, D. J.L.M. De Mey, H. C.J. Van Der Mijle, D. E. Moes, C. J.L. Molenaar, P. A. Neijenhuis, M. J. Nieboer, K. Nielsen, G. A.P. Nieuwenhuijzen, P. Oomen, N. Van Oorschot, K. Parry, K. C.M.J. Peeters, T. Paulides, I. Paulusma, F. B. Poelmann, S. W. Polle, P. Poortman, M. H. Raber, R. J. Renger, B. M.M. Reiber, R. Roukema, W. M.J. De Ruijter, M. J.A.M. Russchen, H. J.T. Rutten, J. Scheerhoorn, S. Scheurs, H. Schippers, V. N.E. Schuermans, H. J. Schuijt, J. C. Sierink, C. Sietses, R. Silvis, J. Van Der Slegt, G. D. Slooter, M. Van Der Sluis, P. Van Der Sluis, N. Smakman, D. Smit, A. B. Smits, T. C. Van Sprundel, D. J.A. Sonneveld, C. Steur, J. Straatman, M. C. Struijs, H. A. Swank, A. K. Talsma, M. Tenhagen, J. A. M. G. Tol, J. L. Tolenaar, L. Tseng, J. B. Tuynman, M. J.F. Van Veen, S. C. Veltkamp, A. W. H. Van De Ven, L. Verkoele, M. Vermaas, H. P. Versteegh, L. Verslijs, T. Visser, H. De Wilt, D. Van Uden, W. J. Vles, R. J. De Vos Tot Nederveen Cappel, H. S. De Vries, S. T. Van Vugt, G. Vugts, J. A. Wegdam, T. J. Weijs, B. J. Van Wely, M. Westerterp, H. L. Van Westreenen, B. Wiering, N. A.T. Wijffels, A. A. Wijkmans, L. H. Wijngaarden, M. Van De Wilt, F. Wit, E. S. Van Der Zaag, D. D.E. Zimmerman, T. L.R. Zwols

^*Corresponding author voor dit werk

Robotics and image-guided minimally-invasive surgery (ROBOTICS)

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Samenvatting

BACKGROUND: Acute resection for left-sided obstructive colon carcinoma is thought to be associated with a higher mortality risk than a bridge-to-surgery approach using decompressing stoma or self-expandable metal stent, but prediction models are lacking.

OBJECTIVE: This study aimed to determine the influence of treatment strategy on mortality within 90 days from the first intervention in patients presenting with left-sided obstructive colon carcinoma.

DESIGN: This was a national multicenter cohort study that used data from a prospective national audit.

SETTINGS: The study was performed in 75 Dutch hospitals.

PATIENTS: Patients were included if they underwent resection with curative intent for left-sided obstructive colon carcinoma between 2009 and 2016.

INTERVENTIONS: First intervention was either acute resection, bridge to surgery with self-expandable metallic stent, or bridge to surgery with decompressing stoma.

MAIN OUTCOME MEASURES: The main outcome measure was 90-day mortality after the first intervention. Risk factors were identified using multivariable logistic analysis. Subsequently, a risk model was developed.

RESULTS: In total, 2395 patients were included, with the first intervention consisting of acute resection in 1848 patients (77%), stoma as bridge to surgery in 332 patients (14%), and stent as bridge to surgery in 215 patients (9%). Overall, 152 patients (6.3%) died within 90 days from the first intervention. A decompressing stoma was independently associated with lower 90-day mortality risk (HR, 0.27; 95% CI, 0.094-0.62). Other independent predictors for mortality were age, ASA classification, tumor location, and index levels of serum creatinine and C-reactive protein. The constructed risk model had an area under the curve of 0.84 (95% CI, 0.81-0.87).

LIMITATIONS: Only patients who underwent surgical resection were included.

CONCLUSIONS: Treatment strategy had a significant impact on 90-day mortality. A decompressing stoma considerably lowers the risk of mortality, especially in older and frail patients. The developed risk model needs further external validation.

Originele taal-2	English
Pagina's (van-tot)	1309-1318
Aantal pagina's	10
Tijdschrift	Diseases of the Colon and Rectum
Volume	66
Nummer van het tijdschrift	10
DOI's	https://doi.org/10.1097/DCR.0000000000002382
Status	Published - okt.-2023

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10.1097/DCR.0000000000002382

Predicting Mortality Within 90 Days of First Intervention in Patients With Left-Sided Obstructive Colon CancerFinal publisher's version, 979 KBLicentie: Taverne

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Burghgraef, T. A., Bakker, I. S., Veld, J. V., Wijsmuller, A. R., Amelung, F. J., Bemelman, W. A., Ter Borg, F., Van Hooft, J. E., Siersema, P. D., Tanis, P. J., Consten, E. C. J., Algera, H., Algie, G. D., Andeweg, C. S., Argillander, T. E., Arron, M. N. N. J., Arts, K., Aufenacker, T. H. J., Van Basten Batenburg, M., ... Zwols, T. L. R. (2023). Predicting Mortality Within 90 Days of First Intervention in Patients with Left-Sided Obstructive Colon Cancer. Diseases of the Colon and Rectum, 66(10), 1309-1318. https://doi.org/10.1097/DCR.0000000000002382

@article{c78d9bb879d1450eac0544cede0ae262,

title = "Predicting Mortality Within 90 Days of First Intervention in Patients with Left-Sided Obstructive Colon Cancer",

abstract = "BACKGROUND: Acute resection for left-sided obstructive colon carcinoma is thought to be associated with a higher mortality risk than a bridge-to-surgery approach using decompressing stoma or self-expandable metal stent, but prediction models are lacking. OBJECTIVE: This study aimed to determine the influence of treatment strategy on mortality within 90 days from the first intervention in patients presenting with left-sided obstructive colon carcinoma. DESIGN: This was a national multicenter cohort study that used data from a prospective national audit. SETTINGS: The study was performed in 75 Dutch hospitals. PATIENTS: Patients were included if they underwent resection with curative intent for left-sided obstructive colon carcinoma between 2009 and 2016. INTERVENTIONS: First intervention was either acute resection, bridge to surgery with self-expandable metallic stent, or bridge to surgery with decompressing stoma. MAIN OUTCOME MEASURES: The main outcome measure was 90-day mortality after the first intervention. Risk factors were identified using multivariable logistic analysis. Subsequently, a risk model was developed. RESULTS: In total, 2395 patients were included, with the first intervention consisting of acute resection in 1848 patients (77%), stoma as bridge to surgery in 332 patients (14%), and stent as bridge to surgery in 215 patients (9%). Overall, 152 patients (6.3%) died within 90 days from the first intervention. A decompressing stoma was independently associated with lower 90-day mortality risk (HR, 0.27; 95% CI, 0.094-0.62). Other independent predictors for mortality were age, ASA classification, tumor location, and index levels of serum creatinine and C-reactive protein. The constructed risk model had an area under the curve of 0.84 (95% CI, 0.81-0.87). LIMITATIONS: Only patients who underwent surgical resection were included. CONCLUSIONS: Treatment strategy had a significant impact on 90-day mortality. A decompressing stoma considerably lowers the risk of mortality, especially in older and frail patients. The developed risk model needs further external validation. ",

keywords = "Acute resection, Bridge to surgery, Decompressing stoma, Left-sided obstructive colon carcinoma, Mortality, Self-expandable metal stent",

author = "Burghgraef, {Thijs A.} and Bakker, {Ilsalien S.} and Veld, {Joyce V.} and Wijsmuller, {Arthur R.} and Amelung, {Femke J.} and Bemelman, {Willem A.} and {Ter Borg}, Frank and {Van Hooft}, {Jeanin E.} and Siersema, {Peter D.} and Tanis, {Pieter J.} and Consten, {Esther C.J.} and H. Algera and Algie, {G. D.} and Andeweg, {C. S.} and Argillander, {T. E.} and Arron, {M. N.N.J.} and K. Arts and Aufenacker, {T. H.J.} and {Van Basten Batenburg}, M. and Bastiaansen, {A. J.N.M.} and Beets, {G. L.} and {Van Den Berg}, A. and {Van De Beukel}, B. and Blom, {R. L.G.M.} and B. Blomberg and Boerma, {E. G.} and {Den Boer}, {F. C.} and Borstlap, {W. A.A.} and Bouvy, {N. D.} and Bouwman, {J. E.} and Boye, {N. D.A.} and Brandt-Kerkhof, {A. R.M.} and Bransma, {H. T.} and A. Breijer and {Van Den Broek}, {W. T.} and Broker, {M. E.E.} and Burbach, {J. P.M.} and Bruns, {E. R.J.} and Crolla, {R. M.P.H.} and Daniels, {M. Dam, L.} and Dekker, {J. W.T.} and A. Demirkiran and {Van Dongen}, {K. W.} and Durmaz, {S. F.} and {Van Esch}, A. and {Van Essen}, {J. A.} and P. Fockens and Foppen, {J. W.} and Furnee, {E. J.B.} and {Van Geloven}, {A. A.W.} and Gerhards, {M. F.} and Gorter, {E. A.} and {Van Grevenstein}, {W. M.U.} and {Van Groningen}, J. and {De Groot-Van Veen}, {I. A.J.} and Haak, {H. E.} and {De Haas}, {J. W.A.} and {Van Hagen}, P. and {Van Halsema}, {E. E.} and Hamminga, {J. T.H.} and K. Havenga and {Van Den Hengel}, B. and {Van Der Harst}, E. and J. Heemskerk and J. Heeren and Heijnen, {B. H.M.} and L. Heijnen and Heikens, {J. T.} and {Van Heinsbergen}, M. and Hess, {D. A.} and N. Heuchemer and C. Hoff and W. Hogendoorn and Houdijk, {A. P.J.} and N. Hugen and B. Inberg and Janssen, {T. L.} and {Jean Pierre}, D. and {De Jong}, {W. J.} and Jongen, {A. C.H.M.} and Kamman, {A. V.} and Klaase, {J. M.} and W. Kelder and Kelling, {E. F.} and R. Klicks and {De Klein}, {G. W.} and Kloppenberg, {F. W.H.} and Konsten, {J. L.M.} and Koolen, {L. J.E.R.} and V. Kornmann and Kortekaas, {R. T.J.} and A. Kreiter and B. Lamme and Lange, {J. F.} and T. Lettinga and D. Lips and G. Lo and F. Logeman and {Van Loon}, {Y. T.} and {Lutke Holzik}, {M. F.} and Marres, {C. C.M.} and I. Masselink and A. Mearadji and G. Meisen and Menon, {A. G.} and Merkus, {J. W.S.} and {De Mey}, {D. J.L.M.} and {Van Der Mijle}, {H. C.J.} and Moes, {D. E.} and Molenaar, {C. J.L.} and Neijenhuis, {P. A.} and Nieboer, {M. J.} and K. Nielsen and Nieuwenhuijzen, {G. A.P.} and P. Oomen and {Van Oorschot}, N. and K. Parry and Peeters, {K. C.M.J.} and T. Paulides and I. Paulusma and Poelmann, {F. B.} and Polle, {S. W.} and P. Poortman and Raber, {M. H.} and Renger, {R. J.} and Reiber, {B. M.M.} and R. Roukema and {De Ruijter}, {W. M.J.} and Russchen, {M. J.A.M.} and Rutten, {H. J.T.} and J. Scheerhoorn and S. Scheurs and H. Schippers and Schuermans, {V. N.E.} and Schuijt, {H. J.} and Sierink, {J. C.} and C. Sietses and R. Silvis and {Van Der Slegt}, J. and Slooter, {G. D.} and {Van Der Sluis}, M. and {Van Der Sluis}, P. and N. Smakman and D. Smit and Smits, {A. B.} and {Van Sprundel}, {T. C.} and Sonneveld, {D. J.A.} and C. Steur and J. Straatman and Struijs, {M. C.} and Swank, {H. A.} and Talsma, {A. K.} and M. Tenhagen and Tol, {J. A. M. G.} and Tolenaar, {J. L.} and L. Tseng and Tuynman, {J. B.} and {Van Veen}, {M. J.F.} and Veltkamp, {S. C.} and {Van De Ven}, {A. W. H.} and L. Verkoele and M. Vermaas and Versteegh, {H. P.} and L. Verslijs and T. Visser and {De Wilt}, H. and {Van Uden}, D. and Vles, {W. J.} and {De Vos Tot Nederveen Cappel}, {R. J.} and {De Vries}, {H. S.} and {Van Vugt}, {S. T.} and G. Vugts and Wegdam, {J. A.} and Weijs, {T. J.} and {Van Wely}, {B. J.} and M. Westerterp and {Van Westreenen}, {H. L.} and B. Wiering and Wijffels, {N. A.T.} and Wijkmans, {A. A.} and Wijngaarden, {L. H.} and {Van De Wilt}, M. and F. Wit and {Van Der Zaag}, {E. S.} and Zimmerman, {D. D.E.} and Zwols, {T. L.R.}",

year = "2023",

month = oct,

doi = "10.1097/DCR.0000000000002382",

language = "English",

volume = "66",

pages = "1309--1318",

journal = "Diseases of the Colon and Rectum",

issn = "0012-3706",

publisher = "LIPPINCOTT WILLIAMS & WILKINS",

number = "10",

}

Burghgraef, TA, Bakker, IS, Veld, JV, Wijsmuller, AR, Amelung, FJ, Bemelman, WA, Ter Borg, F, Van Hooft, JE, Siersema, PD, Tanis, PJ, Consten, ECJ, Algera, H, Algie, GD, Andeweg, CS, Argillander, TE, Arron, MNNJ, Arts, K, Aufenacker, THJ, Van Basten Batenburg, M, Bastiaansen, AJNM, Beets, GL, Van Den Berg, A, Van De Beukel, B, Blom, RLGM, Blomberg, B, Boerma, EG, Den Boer, FC, Borstlap, WAA, Bouvy, ND, Bouwman, JE, Boye, NDA, Brandt-Kerkhof, ARM, Bransma, HT, Breijer, A, Van Den Broek, WT, Broker, MEE, Burbach, JPM, Bruns, ERJ, Crolla, RMPH, Daniels, MDL, Dekker, JWT, Demirkiran, A, Van Dongen, KW, Durmaz, SF, Van Esch, A, Van Essen, JA, Fockens, P, Foppen, JW, Furnee, EJB, Van Geloven, AAW, Gerhards, MF, Gorter, EA, Van Grevenstein, WMU, Van Groningen, J, De Groot-Van Veen, IAJ, Haak, HE, De Haas, JWA, Van Hagen, P, Van Halsema, EE, Hamminga, JTH, Havenga, K, Van Den Hengel, B, Van Der Harst, E, Heemskerk, J, Heeren, J, Heijnen, BHM, Heijnen, L, Heikens, JT, Van Heinsbergen, M, Hess, DA, Heuchemer, N, Hoff, C, Hogendoorn, W, Houdijk, APJ, Hugen, N, Inberg, B, Janssen, TL, Jean Pierre, D, De Jong, WJ, Jongen, ACHM, Kamman, AV, Klaase, JM, Kelder, W, Kelling, EF, Klicks, R, De Klein, GW, Kloppenberg, FWH, Konsten, JLM, Koolen, LJER, Kornmann, V, Kortekaas, RTJ, Kreiter, A, Lamme, B, Lange, JF, Lettinga, T, Lips, D, Lo, G, Logeman, F, Van Loon, YT, Lutke Holzik, MF, Marres, CCM, Masselink, I, Mearadji, A, Meisen, G, Menon, AG, Merkus, JWS, De Mey, DJLM, Van Der Mijle, HCJ, Moes, DE, Molenaar, CJL, Neijenhuis, PA, Nieboer, MJ, Nielsen, K, Nieuwenhuijzen, GAP, Oomen, P, Van Oorschot, N, Parry, K, Peeters, KCMJ, Paulides, T, Paulusma, I, Poelmann, FB, Polle, SW, Poortman, P, Raber, MH, Renger, RJ, Reiber, BMM, Roukema, R, De Ruijter, WMJ, Russchen, MJAM, Rutten, HJT, Scheerhoorn, J, Scheurs, S, Schippers, H, Schuermans, VNE, Schuijt, HJ, Sierink, JC, Sietses, C, Silvis, R, Van Der Slegt, J, Slooter, GD, Van Der Sluis, M, Van Der Sluis, P, Smakman, N, Smit, D, Smits, AB, Van Sprundel, TC, Sonneveld, DJA, Steur, C, Straatman, J, Struijs, MC, Swank, HA, Talsma, AK, Tenhagen, M, Tol, JAMG, Tolenaar, JL, Tseng, L, Tuynman, JB, Van Veen, MJF, Veltkamp, SC, Van De Ven, AWH, Verkoele, L, Vermaas, M, Versteegh, HP, Verslijs, L, Visser, T, De Wilt, H, Van Uden, D, Vles, WJ, De Vos Tot Nederveen Cappel, RJ, De Vries, HS, Van Vugt, ST, Vugts, G, Wegdam, JA, Weijs, TJ, Van Wely, BJ, Westerterp, M, Van Westreenen, HL, Wiering, B, Wijffels, NAT, Wijkmans, AA, Wijngaarden, LH, Van De Wilt, M, Wit, F, Van Der Zaag, ES, Zimmerman, DDE & Zwols, TLR 2023, 'Predicting Mortality Within 90 Days of First Intervention in Patients with Left-Sided Obstructive Colon Cancer', Diseases of the Colon and Rectum, vol. 66, nr. 10, blz. 1309-1318. https://doi.org/10.1097/DCR.0000000000002382

TY - JOUR

T1 - Predicting Mortality Within 90 Days of First Intervention in Patients with Left-Sided Obstructive Colon Cancer

AU - Burghgraef, Thijs A.

AU - Bakker, Ilsalien S.

AU - Veld, Joyce V.

AU - Wijsmuller, Arthur R.

AU - Amelung, Femke J.

AU - Bemelman, Willem A.

AU - Ter Borg, Frank

AU - Van Hooft, Jeanin E.

AU - Siersema, Peter D.

AU - Tanis, Pieter J.

AU - Consten, Esther C.J.

AU - Algera, H.

AU - Algie, G. D.

AU - Andeweg, C. S.

AU - Argillander, T. E.

AU - Arron, M. N.N.J.

AU - Arts, K.

AU - Aufenacker, T. H.J.

AU - Van Basten Batenburg, M.

AU - Bastiaansen, A. J.N.M.

AU - Beets, G. L.

AU - Van Den Berg, A.

AU - Van De Beukel, B.

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

AU - Blomberg, B.

AU - Boerma, E. G.

AU - Den Boer, F. C.

AU - Borstlap, W. A.A.

AU - Bouvy, N. D.

AU - Bouwman, J. E.

AU - Boye, N. D.A.

AU - Brandt-Kerkhof, A. R.M.

AU - Bransma, H. T.

AU - Breijer, A.

AU - Van Den Broek, W. T.

AU - Broker, M. E.E.

AU - Burbach, J. P.M.

AU - Bruns, E. R.J.

AU - Crolla, R. M.P.H.

AU - Daniels, M. Dam, L.

AU - Dekker, J. W.T.

AU - Demirkiran, A.

AU - Van Dongen, K. W.

AU - Durmaz, S. F.

AU - Van Esch, A.

AU - Van Essen, J. A.

AU - Fockens, P.

AU - Foppen, J. W.

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PY - 2023/10

Y1 - 2023/10

N2 - BACKGROUND: Acute resection for left-sided obstructive colon carcinoma is thought to be associated with a higher mortality risk than a bridge-to-surgery approach using decompressing stoma or self-expandable metal stent, but prediction models are lacking. OBJECTIVE: This study aimed to determine the influence of treatment strategy on mortality within 90 days from the first intervention in patients presenting with left-sided obstructive colon carcinoma. DESIGN: This was a national multicenter cohort study that used data from a prospective national audit. SETTINGS: The study was performed in 75 Dutch hospitals. PATIENTS: Patients were included if they underwent resection with curative intent for left-sided obstructive colon carcinoma between 2009 and 2016. INTERVENTIONS: First intervention was either acute resection, bridge to surgery with self-expandable metallic stent, or bridge to surgery with decompressing stoma. MAIN OUTCOME MEASURES: The main outcome measure was 90-day mortality after the first intervention. Risk factors were identified using multivariable logistic analysis. Subsequently, a risk model was developed. RESULTS: In total, 2395 patients were included, with the first intervention consisting of acute resection in 1848 patients (77%), stoma as bridge to surgery in 332 patients (14%), and stent as bridge to surgery in 215 patients (9%). Overall, 152 patients (6.3%) died within 90 days from the first intervention. A decompressing stoma was independently associated with lower 90-day mortality risk (HR, 0.27; 95% CI, 0.094-0.62). Other independent predictors for mortality were age, ASA classification, tumor location, and index levels of serum creatinine and C-reactive protein. The constructed risk model had an area under the curve of 0.84 (95% CI, 0.81-0.87). LIMITATIONS: Only patients who underwent surgical resection were included. CONCLUSIONS: Treatment strategy had a significant impact on 90-day mortality. A decompressing stoma considerably lowers the risk of mortality, especially in older and frail patients. The developed risk model needs further external validation.

AB - BACKGROUND: Acute resection for left-sided obstructive colon carcinoma is thought to be associated with a higher mortality risk than a bridge-to-surgery approach using decompressing stoma or self-expandable metal stent, but prediction models are lacking. OBJECTIVE: This study aimed to determine the influence of treatment strategy on mortality within 90 days from the first intervention in patients presenting with left-sided obstructive colon carcinoma. DESIGN: This was a national multicenter cohort study that used data from a prospective national audit. SETTINGS: The study was performed in 75 Dutch hospitals. PATIENTS: Patients were included if they underwent resection with curative intent for left-sided obstructive colon carcinoma between 2009 and 2016. INTERVENTIONS: First intervention was either acute resection, bridge to surgery with self-expandable metallic stent, or bridge to surgery with decompressing stoma. MAIN OUTCOME MEASURES: The main outcome measure was 90-day mortality after the first intervention. Risk factors were identified using multivariable logistic analysis. Subsequently, a risk model was developed. RESULTS: In total, 2395 patients were included, with the first intervention consisting of acute resection in 1848 patients (77%), stoma as bridge to surgery in 332 patients (14%), and stent as bridge to surgery in 215 patients (9%). Overall, 152 patients (6.3%) died within 90 days from the first intervention. A decompressing stoma was independently associated with lower 90-day mortality risk (HR, 0.27; 95% CI, 0.094-0.62). Other independent predictors for mortality were age, ASA classification, tumor location, and index levels of serum creatinine and C-reactive protein. The constructed risk model had an area under the curve of 0.84 (95% CI, 0.81-0.87). LIMITATIONS: Only patients who underwent surgical resection were included. CONCLUSIONS: Treatment strategy had a significant impact on 90-day mortality. A decompressing stoma considerably lowers the risk of mortality, especially in older and frail patients. The developed risk model needs further external validation.

KW - Acute resection

KW - Bridge to surgery

KW - Decompressing stoma

KW - Left-sided obstructive colon carcinoma

KW - Mortality

KW - Self-expandable metal stent

UR - http://www.scopus.com/inward/record.url?scp=85160951914&partnerID=8YFLogxK

U2 - 10.1097/DCR.0000000000002382

DO - 10.1097/DCR.0000000000002382

M3 - Article

C2 - 35522790

AN - SCOPUS:85160951914

SN - 0012-3706

VL - 66

SP - 1309

EP - 1318

JO - Diseases of the Colon and Rectum

JF - Diseases of the Colon and Rectum

IS - 10

ER -

Predicting Mortality Within 90 Days of First Intervention in Patients with Left-Sided Obstructive Colon Cancer

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