title: Management of obstructive colorectal cancer: evaluation of preoperative bowel decompression using ileus tube drainage.
abstract: OBJECTIVE
  This study evaluated a better treatment for patients with obstructive colorectal cancer (CRC) that have a poor prognosis.
  
  
  METHODS
  This study compared the outcomes of 138 patients with obstructive CRC, including 70 primary resections, 50 resections after bowel decompression using an ileus tube, and 18 delayed resections after colostomy.
  
  
  RESULTS
  The ileus tube and delayed resection groups included more left-sided primary lesions. The physiologic POSSUM, types 3-4, tumor size, CEA, and hospital stay of the delayed resection group were different, in comparison to both the primary resection and ileus tube groups. The histopathological type and depth of invasion of the delayed resection group included less well types and more T4 than those of the ileus tube group. The operative blood loss of the delayed resection group was more than that of the ileus tube group. There were no differences in the overall and disease-free survival among the three groups.
  
  
  CONCLUSIONS
  Separately analyzing the data of the right-sided cancer group and the left-sided cancer group demonstrated that primary resection might be acceptable for right-sided obstructive CRC and delayed resection might be done for patients with poorer general conditions (high PPS) and poorer oncological prognostic factors such as more type 3/type 4 cases, a larger tumor size, a less well-differentiated histopathological type, more T4 cases, and a higher CEA level.
authors.affiliation: Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama 641-8510, Japan.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Hotta
authors.forename: Katsunari
authors.initials: K
authors.lastname: Takifuji
authors.forename: Yasuhito
authors.initials: Y
authors.lastname: Kobayashi
authors.forename: Katsuyoshi
authors.initials: K
authors.lastname: Tabuse
authors.forename: Kohsuke
authors.initials: K
authors.lastname: Shimada
authors.forename: Tsunehiro
authors.initials: T
authors.lastname: Maeda
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Nakatani
authors.forename: Osamu
authors.initials: O
authors.lastname: Fukiage
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yamaue
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D003082:Colectomy / Q000379:methods; D015179:Colorectal Neoplasms / Q000150:complications / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003125:Colostomy; D019299:Decompression, Surgical / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D045823:Ileus / Q000209:etiology / Q000601:surgery*; D007902:Length of Stay; D002955:Leucovorin / Q000008:administration & dosage; D008207:Lymphatic Metastasis; D008297:Male; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D002955:Leucovorin; D005472:Fluorouracil