A nomogram model for predicting prognosis of obstructive colorectal cancer

Background The prognosis of obstructive colorectal cancer (oCRC) is worse than that of nonobstructive colorectal cancer. However, no previous study has established an individualized prediction model for the prognosis of patients with oCRC. We aimed to screen the factors that affect the prognosis of oCRC and to use these findings to establish a nomogram model that predicts the individual prognosis of patients with oCRC. Methods This retrospective study collected data of 181 patients with oCRC from three medical hospitals between February 2012 and December 2017. Among them, 129 patients from one hospital were used as the training cohort. Univariate and multivariate analyses were used in this training cohort to select independent risk factors that affect the prognosis of oCRC, and a nomogram model was established. The other 52 patients from two additional hospitals were used as the validation cohort to verify the model. Results Multivariate analysis showed that carcinoembryonic antigen level (p = 0.037, hazard ratio [HR] = 2.872 [1.065–7.740]), N stage (N1 vs. N0, p = 0.028, HR = 3.187 [1.137–8.938]; N2 vs. N0, p = 0.010, HR = 4.098 [1.393–12.051]), and surgical procedures (p = 0.002, HR = 0.299 [0.139–0.643]) were independent prognostic factors of overall survival in patients with oCRC. These factors were used to construct the nomogram model, which showed good concordance and accuracy. Conclusion Carcinoembryonic antigen, N stage, and surgical method are independent prognostic factors for overall survival in patients with oCRC, and the nomogram model can visually display these results.

Prognostic Factors of Patients with Left-sided Obstructive Colorectal Cancer: Post-hoc Analysis of a Retrospective Multi-center Study in the Japan Colonic Stent Safe Procedure Research Group

Background There are many reports on the choice of treatment and prognosis of left-sided obstructive colorectal cancer; only few studies focus on the prognostic factors of LOCRC. Therefore, we analyzed the prognostic factors of left-sided obstructive colorectal cancer by post-hoc analysis of a retrospective multicenter study in the Japan Colonic Stent Safe Procedure Research Group. Methods This study was conducted as a post-hoc analysis of a retrospective multi-center observational study which enrolled a total of 301 patients, with the aim of investigating prognostic factors for relapse-free survival. The relationships among sex, age, decompression for bridge to surgery, depth of invasion, lymph node metastasis, postoperative complications, adjuvant chemotherapy, carcinoembryonic antigen, carbohydrate antigen 19 − 9, neutrophil-to-lymphocyte ratio, and relapse-free survival were examined. Results T3 of depth of invasion, negative postoperative complication (grade 0–1 of Clavien-Dindo classification), and administration of adjuvant chemotherapy (in Stage III) indicated a significantly good prognosis using Cox’s univariate analyses. Lymph node metastasis was not selected as a prognostic factor. Then, excluding patients with < 12 harvested lymph nodes, which may indicate stage migration, lymph node metastasis was also determined to be a prognostic factor. Using Cox’s multivariate analysis, depth of invasion, lymph node metastasis (excluding N0 cases with < 12 harvested lymph nodes), and adjuvant chemotherapy (all cases) were found to be prognostic factors. Conclusions In left-sided obstructive colorectal cancer, depth of invasion, lymph node metastasis and adjuvant chemotherapy were found to be prognostic factors, and patients with < 12 dissected lymph nodes could cause stage migration. This may result in disadvantages, such as not being able to receive adjuvant chemotherapy.

Colonic Stent Placement May Reduce Mortality Rate and Length of Hospitalization in Obstructive Colorectal Cancer Cases: a Propensity Score-matched Analysis Using a Nationwide Database in Japan

Background and aims: Self-expandable metallic stent (SEMS) is widely used for obstructive colorectal cancer (OCC). Both SEMS and urgent surgery have several merits and demerits. This study aimed to clarify the efficacy of SEMS by comparing the mortality rate after the hospitalization between SEMS and urgent surgery for OCC.Methods: We collected OCC patients’ data using the Diagnosis Procedure Combination (DPC) database system. We divided eligible patients into the SEMS and urgent surgery groups using propensity score matching, and compared in-hospital death rates, length of hospitalization, and medical costs. We also conducted logistic regression analysis to identify clinical factors affecting in-hospital deaths.Results: We enrolled 17,140 cases after propensity score matching. SEMS reduced the in-hospital death rate compared to urgent surgery (2.0% vs. 3.6%, P < 0.0001). Length of hospitalization was shorter in the SEMS group than in the urgent surgery group (16 vs. 25 days, P < 0.0001). Medical costs were lower in the SEMS group than in the urgent surgery group (1,663,550 vs. 2,424,082 JPY, P < 0.0001). Multivariate analysis also showed that SEMS reduced in-hospital death (odds ratio = 0.58, 95% confidence interval: 0.50‒0.70, P < 0.0001).Conclusion: SEMS placement for OCC could reduce the mortality rate and shorten the length of hospitalization. These results facilitate considering SEMS with careful judgement for its indication when treating OCC patients.

CLINICAL AND PATHOLOGICAL FEATURES OF COLONIC ILEUS FROM OBSTRUCTIVE COLORECTAL CANCER. ACTUAL CHARACTERISTICS

Purpose: The purpose of this study is to analyze the possible change in the characteristics of patients with colonic ileus from obstructive colorectal cancer in UMHATEM "N. Pirogov ". Material and Methods: For two separate periods of 2 years in the Department of General, Visceral and Emergency Surgery in University Hospital "N. I. Pirogov" from ileus caused by colorectal carcinoma were operated respectively: Group A (1.1.2010-31.12.2011) - 187 patients (average 71.2 years, women were 88, men 99) Group B (1.1.2014-31.12.2015) - 141 patients (average 73.5 years, women were 69, men 72). Results: In group B there was an increase in the infected patients at an earlier stage. There was no significant difference in the localization of the tumor process in the two groups. In contrast to the increased number of patients hospitalized at an earlier ileus stage, there was no difference in the two groups according to the tumor stage. Conclusions: Emergency surgery is indicated for cases with full bowel obstruction and significant prediction of rupture. Surgery procedure like proximal colostomy is reccomended for elderly patients and complicated comorbidity. Primary procedure like segmental and subtotal colectomy is appropriate for patients in good condition. Segmental resection is favorable in elderly patients and those with shock who may not tolerate lengthy surgery.