Are a Dilated Cecum and Small Bowel Distention on CT Imaging Associated with Worse Postoperative Outcomes in Left-Sided Obstructive Colon Cancer? A Population-Based Study.

Abstract

Introduction: The aim of this study was to evaluate whether a dilated cecum (≥9 cm) and small-bowel distention on preoperative CT are associated with worse postoperative outcomes in patients with left-sided obstructive colon cancer (LSOCC) undergoing an emergency resection (ER) or a bridge-to-surgery (BTS).

Methods: A national multicenter cohort study was conducted using data from a prospective audit performed in 75 Dutch hospitals. Patients undergoing curative resection for LSOCC (2009-2016) with available CT data on cecal diameter and small-bowel distention were included. Primary outcomes were 90-day postoperative complications and mortality, analyzed by multivariable logistic regression and stratified by treatment strategy (ER vs. BTS).

Results: Of 1,282 patients, 967 underwent ER and 315 BTS. Among ER patients, concurrent cecal dilatation (≥9 cm) and small-bowel distention were independently associated with higher 90-day complications (58.8% vs. 42.7%; OR 1.91, 95% CI: 1.25-2.93; p = 0.003) and 30-day mortality (7.0% vs. 2.7%; p = 0.038). These associations were absent in BTS patients. In this high-risk CT subgroup, BTS yielded fewer complications (37.4% vs. 58.8%), lower permanent stoma rates (23.0% vs. 52.1%), and higher primary anastomosis rates (85.4% vs. 30.6%). In young (<70 years) and healthy patients (ASA I-II) without a dilated coecum or small bowel on CT, no outcome differences were found between ER and BTS.

Conclusion: Concurrent cecal dilatation and small-bowel distention on CT identify high-risk patients after ER, whereas BTS mitigates these risks. Routine CT-assessment may aid individualized management.