Completion of preoperative chemotherapy and surgical outcome in patients with stenotic colon cancer without obstruction: A cohort study

IF 2.7 2区医学 Q1 SURGERY

Surgery Pub Date : 2025-07-03 DOI:10.1016/j.surg.2025.109533

Jinquan Zhang MD , Siqi He MD , Xiaolin Wu MD , Runxian Wang MD , Huabin Hu MD , Jianwei Zhang MD , Jianping Wang MD , Yanhong Deng MD , Zerong Cai MD , Ruoxu Dou MD

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Abstract

Background

Current evidence has shown an oncologic benefit of preoperative chemotherapy for patients with locally advanced and metastatic colon cancer. However, some patients present with stenosis that blocks the colonoscope but without symptomatic obstruction. Whether the stenosis will progress to obstruction during chemotherapy is unknown, and this uncertainty may encourage unnecessary diversion or stenting, or impede optimal treatment.

Methods

We retrospectively analyzed 465 consecutive patients with endoscopically stenotic colon cancer without symptomatic obstruction in a quaternary referral center from 2013 to 2020. Patients were grouped into upfront surgery (361) and preoperative chemotherapy (104). Clinical courses of patients receiving preoperative chemotherapy were described, with expedited surgery as the primary outcome.

Results

Obstruction or perforation occurred in 25 of 104 (24.0%) patients receiving preoperative chemotherapy, of which 11 discontinued chemotherapy and received expedited surgery, and 14 resumed chemotherapy after stent or medical treatment. In total, 93 (89.4%) patients received elective surgery after preoperative chemotherapy. In addition, the preoperative chemotherapy group demonstrated a 41.3% objective response rate.

Conclusion

Three of 4 patients with stenotic colon cancer without symptomatic obstruction can complete preoperative chemotherapy uneventfully. Expedited surgery was needed in 10.6% because of obstruction or perforation during chemotherapy.

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无梗阻的狭窄性结肠癌患者的术前化疗完成和手术结果：一项队列研究

背景：目前的证据表明，术前化疗对局部晚期和转移性结肠癌患者有肿瘤学上的益处。然而，一些患者出现狭窄阻塞结肠镜检查，但没有症状性梗阻。在化疗期间狭窄是否会发展为梗阻尚不清楚，这种不确定性可能会鼓励不必要的转移或支架置入，或阻碍最佳治疗。方法回顾性分析2013 - 2020年在某四级转诊中心连续就诊的465例无症状性梗阻的内镜下狭窄性结肠癌患者。患者分为术前手术组（361例）和术前化疗组（104例）。描述了患者接受术前化疗的临床过程，以加速手术为主要结局。结果104例术前化疗患者中有25例（24.0%）出现血管梗阻或穿孔，其中11例停止化疗并加速手术，14例经支架或药物治疗后恢复化疗。术前化疗后择期手术93例（89.4%）。术前化疗组客观有效率为41.3%。结论4例无症状性梗阻的狭窄性结肠癌患者中有3例能顺利完成术前化疗。10.6%的患者在化疗期间因梗阻或穿孔而需要加速手术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Surgery 医学-外科

CiteScore

5.40

自引率

5.30%

发文量

687

审稿时长

64 days

期刊介绍： For 66 years, Surgery has published practical, authoritative information about procedures, clinical advances, and major trends shaping general surgery. Each issue features original scientific contributions and clinical reports. Peer-reviewed articles cover topics in oncology, trauma, gastrointestinal, vascular, and transplantation surgery. The journal also publishes papers from the meetings of its sponsoring societies, the Society of University Surgeons, the Central Surgical Association, and the American Association of Endocrine Surgeons.