Effect of Preoperative Colonic Drainage for Obstructing Colorectal Cancer

Abstract

Obstructing colorectal cancer (OCRC) is believed to indicate poorer long-term survival. The purpose of this study was to compare retrospectively perioperative safety and longterm results in patients undergoing surgery for OCRC following preoperative colonic decompression with that in those undergoing elective surgery alone for nonobstructing colorectal cancer (CRC). A total of 656 consecutive CRC patients undergoing colectomy between 2001 and 2011 at our institute were eligible for inclusion in the study. The patients were divided into an OCRC group, which included 104 patients undergoing colectomy with preoperative colonic decompression, and a CRC group, which included 552 patients undergoing colectomy alone. Morbidity, mortality, and prognosis were assessed. In the OCRC group, decompression was performed by nasointestinal tube in 42 patients (40.4%), transanal tube in 15 (14.4%), and colostomy in 47 (45.2%). The mortality rate was 0% in the OCRC group and 0.4% in the CRC group (2 of 552 patients). The morbidity rate was 44.8% in the OCRC group (48 of 104 patients) and 36.6% in the CRC group (202 of 552 patients). The 5-year overall survival rate was 69.5% in the OCRC group and 72.9% in the CRC group [hazard ratio 0.76; 95% confidence interval, 0.35 to 1.16; P ¼ 0.48)]. No statistically significant difference in survival was observed between the 2 groups in stage II, III, or IV, or overall. No difference was observed in safety or survival between advanced OCRC patients undergoing preoperative colonic decompression and advanced non-obstructing CRC patients undergoing surgery alone. While some studies have reported that OCRC has a poorer prognosis than nonobstructing CRC, 4,5 others have found no difference. 6,7 This poses a problem in the surgical management of OCRC.In many institutions, 1-stage primary resection is recommended for OCRC, as this allows colostomy and further nonsurgical drainage for the obstruction to be avoided. [8][9][10] On the other hand, disruption of anastomosis was observed in more than 50% of cases in which resection was performed as initial surgery without surgical or nonsurgical decompression for the obstruction, threatening overall deterioration in the patient's condition.Therefore, some have recommended decompression as a means of avoiding this problem. 11However, the effectiveness of surgical or nonsurgical decompression for OCRC remains controversial.Since January 2001, we have performed preoperative decompression in all OCRC patients to reduce the rate of surgical complications and hospital death.The purpose of this study was to compare retrospectively perioperative safety and long-term results in patients undergoing elective surgery for advanced OCRC after preoperative colonic decompression with that in patients undergoing elective surgery alone for advanced nonobstructing CRC. Materials and Methods Patient population and methodsBetween January 2001 and December 2011, a total of 879 consecutive stage I-IV colorectal cancer patients underwent colectomy for primary histologically pr...