TY - JOUR
T1 - Risk factors for a permanent stoma after resection of left-sided obstructive colon cancer ? A prediction model
AU - Zamaray, Bobby
AU - Veld, J. V.
AU - Dutch Snapshot Research Group (DSRG), Dutch Complex Colon Cancer Initiative (DCCCI)
AU - Burghgraef, T. A.
AU - Brohet, R.
AU - van Westreenen, H. L.
AU - van Hooft, J. E.
AU - Siersema, P. D.
AU - Tanis, P. J.
AU - Consten, E. C. J.
AU - Amelung, F. J.
AU - Bastiaenen, V. P.
AU - van der Bilt, J. D. W.
AU - Draaisma, W. A.
AU - de Groot, J. W. B.
AU - Kok, N. F. M.
AU - Kusters, M.
AU - Nagtegaal, I. D.
AU - Zwanenburg, E. S.
AU - Aalbers, A. G. J.
N1 - Funding Information: All mentioned funding sources had no role in the design and conduct of the study. The study was funded by a grant from the Dutch Cancer Foundation (KWF; ID:11109) and Citrienfonds. Dr. Van Hooft reported a grant from Cook Medical and a consultancy fee from Boston Scientific, Medtronics and Olympus. Dr. P.D. Siersema received unrestricted grants from Pentax (Japan), Norgine (UK), Motus GI (USA), MicroTech (China) and eNose (Netherlands), and is in the advisory board of Motus GI (USA) and Boston Scientific (USA). The authors declare no other conflict of interest. The research plan was not preregistered. Funding Information: Dutch Snapshot Research Group collaborators (DSRG): 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, W.A. Bemelman, A. van den Berg, B. van de Beukel, R.L.G.M. Blom, B. Blomberg, E.G. Boerma, F.C. den Boer, F. ter Borg, 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, M.J. Nieboer, K. Nielsen, G.A.P. Nieuwenhuijzen, P.A. Neijenhuis, 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, J.H.W. 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. Publisher Copyright: © 2022 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology
PY - 2023/4
Y1 - 2023/4
N2 - Introduction: In patients with left-sided obstructive colon cancer (LSOCC), a stoma is often constructed as part of primary treatment, but with a considerable risk of becoming a permanent stoma (PS). The aim of this retrospective multicentre cohort is to identify risk factors for a PS in LSOCC and to develop a pre- and postoperative prediction model for PS. Materials and methods: Data was retrospectively obtained from 75 hospitals in the Netherlands. Patients who had curative resection of LSOCC between January 1, 2009 to December 31, 2016 were included with a minimum follow-up of 6 months after resection. The interventions analysed were emergency resection, decompressing stoma or stent as bridge-to-elective resection. Main outcome measure was presence of PS at the end of follow-up. Multivariable logistic regression analysis was performed to identify risk factors for PS at primary presentation (T0) and after resection, in patients having a stoma in situ (T1). These risk factors were used to construct a web-based prediction tool. Results: Of 2099 patients included in the study (T0), 779 had a PS (37%). A total of 1275 patients had a stoma in situ directly after resection (T1), of whom 674 had a PS (53%). Median follow-up was 34 months. Multivariable analysis showed that older patients, female sex, high ASA-score and open approach were independent predictors for PS in both the T0 and T1 population. Other predictors at T0 were sigmoid location, low Hb, high CRP, cM1 stage, and emergency resection. At T1, subtotal colectomy, no primary anastomosis, not receiving adjuvant chemotherapy and high pTNM stage were additional predictors. Two predictive models were built, with an AUC of 0.74 for T0 and an AUC of 0.81 for T1. Conclusions: PS is seen in 37% of the patients who have resection of LSOCC. In patients with a stoma in situ directly after resection, 53% PS are seen due to non-reversal. Not only baseline characteristics, but also treatment strategies determine the risk of a PS in patients with LSOCC. The developed predictive models will give physicians insight in the role of the individual variables on the risk of a PS and help in informing the patient about the probability of a PS.
AB - Introduction: In patients with left-sided obstructive colon cancer (LSOCC), a stoma is often constructed as part of primary treatment, but with a considerable risk of becoming a permanent stoma (PS). The aim of this retrospective multicentre cohort is to identify risk factors for a PS in LSOCC and to develop a pre- and postoperative prediction model for PS. Materials and methods: Data was retrospectively obtained from 75 hospitals in the Netherlands. Patients who had curative resection of LSOCC between January 1, 2009 to December 31, 2016 were included with a minimum follow-up of 6 months after resection. The interventions analysed were emergency resection, decompressing stoma or stent as bridge-to-elective resection. Main outcome measure was presence of PS at the end of follow-up. Multivariable logistic regression analysis was performed to identify risk factors for PS at primary presentation (T0) and after resection, in patients having a stoma in situ (T1). These risk factors were used to construct a web-based prediction tool. Results: Of 2099 patients included in the study (T0), 779 had a PS (37%). A total of 1275 patients had a stoma in situ directly after resection (T1), of whom 674 had a PS (53%). Median follow-up was 34 months. Multivariable analysis showed that older patients, female sex, high ASA-score and open approach were independent predictors for PS in both the T0 and T1 population. Other predictors at T0 were sigmoid location, low Hb, high CRP, cM1 stage, and emergency resection. At T1, subtotal colectomy, no primary anastomosis, not receiving adjuvant chemotherapy and high pTNM stage were additional predictors. Two predictive models were built, with an AUC of 0.74 for T0 and an AUC of 0.81 for T1. Conclusions: PS is seen in 37% of the patients who have resection of LSOCC. In patients with a stoma in situ directly after resection, 53% PS are seen due to non-reversal. Not only baseline characteristics, but also treatment strategies determine the risk of a PS in patients with LSOCC. The developed predictive models will give physicians insight in the role of the individual variables on the risk of a PS and help in informing the patient about the probability of a PS.
KW - Bridge-to-surgery
KW - Emergency resection
KW - Left-sided obstructive colon cancer
KW - Permanent stoma
KW - Predictive model
KW - Stent
KW - Stoma
UR - http://www.scopus.com/inward/record.url?scp=85146466033&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ejso.2022.12.008
DO - https://doi.org/10.1016/j.ejso.2022.12.008
M3 - Article
C2 - 36641294
SN - 0748-7983
VL - 49
SP - 738
EP - 746
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 4
ER -