Journal of Minimally Invasive Surgery 2021; 24(3): 128-138  https://doi.org/10.7602/jmis.2021.24.3.128
Which prognostic factors are important for long-term outcomes in symptomatic obstructive colon cancer? A multi-institutional retrospective cohort study
Chang Hwan Kim1, Jung Hoon Bae2, Chul Seung Lee2, Seung-Rim Han2, In Kyu Lee2, Dosang Lee2, Won Kyung Kang3, Ji Hoon Kim4, Bong-Hyeon Kye5, Hyeon-Min Cho5, Seong Taek Oh6, Sang Chul Lee7, Yoon Suk Lee2
1Department of General Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
2Division of Colorectal Surgery, Department of General Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
3Division of Colorectal Surgery, Department of General Surgery, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
4Division of Colorectal Surgery, Department of General Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
5Division of Colorectal Surgery, Department of General Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
6Division of Colorectal Surgery, Department of General Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
7Division of Colorectal Surgery, Department of General Surgery, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
Correspondence to: Yoon Suk Lee
Division of Colorectal Surgery, Department of General Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea
Tel: +82-2-2258-6095
Fax: +82-2-2258-2282
E-mail: yslee@catholic.ac.kr
ORCID:
https://orcid.org/0000-0002-1849-2774
Received: May 14, 2021; Revised: July 6, 2021; Accepted: July 22, 2021; Published online: September 15, 2021.
© The Korean Society of Endoscopic and Laparoscopic Surgeons.

cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Purpose: The prognostic factors in obstructive colon cancer have not been clearly identified. We aimed to identify the prognostic factor to establish optimal treatment strategy in obstructive colon cancer.
Methods: Patients who underwent surgery for primary colon cancer in stages II and III with symptomatic obstruction from 2004 to 2010 in six hospitals were retrospectively collected. Clinicopathological and surgical outcomes were compared between stent insertion and emergent surgery group. Multiple regression analysis and survival curve analysis were used to identify the prognostic factors in symptomatic obstructive colon cancer.
Results: Among 210 patients, 168 patients (80.0%) underwent stent insertion followed by surgery and 42 patients (20.0%) underwent emergent surgery. Laparoscopic approach (55.4% vs. 23.8%, p < 0.001) and adequate lymph node (LN) harvest (≥12) (93.5% vs. 69.0%, p < 0.001) were significantly higher in stent insertion group. In multiple regression analysis, emergent surgery (hazard ratio [HR], 2.153; 95% confidence interval [CI], 1.031–4.495), vascular invasion (HR, 6.257; 95% CI, 2.784–14.061), and omitting adjuvant chemotherapy (HR, 3.107; 95% CI, 1.394–6.925) were independent poor prognostic factors in 5-year overall survival, and N stage (N1: HR, 3.095; 95% CI, 1.316–7.284; N2: HR, 4.156; 95% CI, 1.671–10.333) was the only poor prognostic factor in 5-year disease-free survival.
Conclusion: In symptomatic obstructive colon cancer, emergent surgery, N stage, vascular invasion, and omission of adjuvant chemotherapy were independent poor prognostic factors. Stent insertion is suggested as the initial treatment for symptomatic obstructive colon cancer, and adjuvant chemotherapy is recommended, especially when vascular invasion or LN metastasis is confirmed.
Keywords: Colonic neoplasms, Intestinal obstruction, Self expandable metallic stents, Laparoscopy, Prognosis


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