title: Resection of Obstructive Left-Sided Colon Cancer at a National Level: A Prospective Analysis of Short-Term Outcomes in 1,816 Patients.
abstract: OBJECTIVE
  The prematurely closed Stent-In II trial in patients with left-sided obstructive colon cancer may have influenced clinical decision making in The Netherlands. The aim of this study was to evaluate treatment of left-sided malignant colon obstruction at a population level since then.
  
  
  METHODS
  Short-term outcomes of all patients who underwent resection for left-sided obstructive colon cancer between 2009 and 2012 were assessed based on a prospective national registry.
  
  
  RESULTS
  In total, 1,816 evaluable patients were included; acute resection was performed in 1,485 (81.8%), and endoscopic stent or decompressing stoma followed by resection in 196 (10.8%) and 135 (7.4%), respectively. The use of endoscopic stenting significantly decreased from 18% (2009) to 6% (2012). Overall 30-day or in-hospital mortality rate was 6.9, 5.6, and 3.7%, respectively (p = 0.107). Mortality rate after acute resection was 2.9% in patients <70 [corrected] years, but mortality rates up to 32.2% were observed in high-risk elderly patients.
  
  
  CONCLUSIONS
  Acute resection as first choice treatment seems justified for patients <70 [corrected] years of age given a mortality rate of 3%. For the elderly frail patients, mortality rates over 30% after acute resection stress the need for alternative treatment strategies.
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Pieter J
authors.initials: PJ
authors.lastname: Tanis
authors.forename: Nuno R
authors.initials: NR
authors.lastname: Paulino Pereira
authors.forename: Jeanin E
authors.initials: JE
authors.lastname: van Hooft
authors.forename: Esther C J
authors.initials: EC
authors.lastname: Consten
authors.forename: Willem A
authors.initials: WA
authors.lastname: Bemelman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000706:statistics & numerical data* / Q000639:trends; D003108:Colonic Diseases / Q000209:etiology / Q000601:surgery / Q000628:therapy; D003110:Colonic Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D003113:Colonoscopy / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D011446:Prospective Studies; D012042:Registries; D015607:Stents / Q000706:statistics & numerical data / Q000639:trends; D016896:Treatment Outcome