Are distended small bowels and a dilated cecum on CT-scan associated with worse outcome following emergency resection for left-sided obstructive colon cancer?
EAES Academy. kertzman b. 07/05/22; 366516; P233
Mr. bas kertzman
Contributions
Contributions
Abstract
Background
Emergency resection for left-sided obstructive colon carcinoma (LSOCC) is associated with high morbidity and mortality, especially in patients with a high age or ASA-grade. No other risk factors have yet been identified. Identification of high-risk patients could aid in determining which patients could benefit most from a bridge-to-surgery approach. The aim of this study is therefore to determine whether certain characteristics on CT-scan (small bowel ileus/cecum diameter >9cm) are predictive of a worse outcome.
Methods
Patients were selected from a database that was created through a national collaborative research project. All Dutch patients that underwent resection for LSOCC from 2009 until 2016 of whom both CT characteristics were reported, were included. They were subsequently divided across four groups depending on the presence of a small bowel ileus and a cecal diameter of > or <9cm.
Results
937 patients were included. Patients with both a small bowel ileus and a cecum >9cm had significantly more 90-day complications (44.6% vs. 35%, p=0.036), a higher mortality (6.5 vs. 2.3%, p= 0.047) and more often had a permanent stoma (52 vs. 41.7%, p= 0.026) compared to patients with neither CT characteristics (Table 1). Subgroup analysis of ASA I-II patients also revealed a higher 90-day complication rate in patients with both CT characteristics (57.1 vs. 42.4%, p=0.007). Interestingly, patients with distended small bowels on CT-scan had a very high anastomotic leakage rate compared to the other groups, although not statistically significant when compared to group one (19.3 vs. 9.0%, p=0.062).
Conclusion
Patients presenting with LSOCC that have both a dilated cecum >9cm and a small bowel ileus seem to have a higher risk of complications and death following emergency surgery.
Emergency resection for left-sided obstructive colon carcinoma (LSOCC) is associated with high morbidity and mortality, especially in patients with a high age or ASA-grade. No other risk factors have yet been identified. Identification of high-risk patients could aid in determining which patients could benefit most from a bridge-to-surgery approach. The aim of this study is therefore to determine whether certain characteristics on CT-scan (small bowel ileus/cecum diameter >9cm) are predictive of a worse outcome.
Methods
Patients were selected from a database that was created through a national collaborative research project. All Dutch patients that underwent resection for LSOCC from 2009 until 2016 of whom both CT characteristics were reported, were included. They were subsequently divided across four groups depending on the presence of a small bowel ileus and a cecal diameter of > or <9cm.
Results
937 patients were included. Patients with both a small bowel ileus and a cecum >9cm had significantly more 90-day complications (44.6% vs. 35%, p=0.036), a higher mortality (6.5 vs. 2.3%, p= 0.047) and more often had a permanent stoma (52 vs. 41.7%, p= 0.026) compared to patients with neither CT characteristics (Table 1). Subgroup analysis of ASA I-II patients also revealed a higher 90-day complication rate in patients with both CT characteristics (57.1 vs. 42.4%, p=0.007). Interestingly, patients with distended small bowels on CT-scan had a very high anastomotic leakage rate compared to the other groups, although not statistically significant when compared to group one (19.3 vs. 9.0%, p=0.062).
Conclusion
Patients presenting with LSOCC that have both a dilated cecum >9cm and a small bowel ileus seem to have a higher risk of complications and death following emergency surgery.
Background
Emergency resection for left-sided obstructive colon carcinoma (LSOCC) is associated with high morbidity and mortality, especially in patients with a high age or ASA-grade. No other risk factors have yet been identified. Identification of high-risk patients could aid in determining which patients could benefit most from a bridge-to-surgery approach. The aim of this study is therefore to determine whether certain characteristics on CT-scan (small bowel ileus/cecum diameter >9cm) are predictive of a worse outcome.
Methods
Patients were selected from a database that was created through a national collaborative research project. All Dutch patients that underwent resection for LSOCC from 2009 until 2016 of whom both CT characteristics were reported, were included. They were subsequently divided across four groups depending on the presence of a small bowel ileus and a cecal diameter of > or <9cm.
Results
937 patients were included. Patients with both a small bowel ileus and a cecum >9cm had significantly more 90-day complications (44.6% vs. 35%, p=0.036), a higher mortality (6.5 vs. 2.3%, p= 0.047) and more often had a permanent stoma (52 vs. 41.7%, p= 0.026) compared to patients with neither CT characteristics (Table 1). Subgroup analysis of ASA I-II patients also revealed a higher 90-day complication rate in patients with both CT characteristics (57.1 vs. 42.4%, p=0.007). Interestingly, patients with distended small bowels on CT-scan had a very high anastomotic leakage rate compared to the other groups, although not statistically significant when compared to group one (19.3 vs. 9.0%, p=0.062).
Conclusion
Patients presenting with LSOCC that have both a dilated cecum >9cm and a small bowel ileus seem to have a higher risk of complications and death following emergency surgery.
Emergency resection for left-sided obstructive colon carcinoma (LSOCC) is associated with high morbidity and mortality, especially in patients with a high age or ASA-grade. No other risk factors have yet been identified. Identification of high-risk patients could aid in determining which patients could benefit most from a bridge-to-surgery approach. The aim of this study is therefore to determine whether certain characteristics on CT-scan (small bowel ileus/cecum diameter >9cm) are predictive of a worse outcome.
Methods
Patients were selected from a database that was created through a national collaborative research project. All Dutch patients that underwent resection for LSOCC from 2009 until 2016 of whom both CT characteristics were reported, were included. They were subsequently divided across four groups depending on the presence of a small bowel ileus and a cecal diameter of > or <9cm.
Results
937 patients were included. Patients with both a small bowel ileus and a cecum >9cm had significantly more 90-day complications (44.6% vs. 35%, p=0.036), a higher mortality (6.5 vs. 2.3%, p= 0.047) and more often had a permanent stoma (52 vs. 41.7%, p= 0.026) compared to patients with neither CT characteristics (Table 1). Subgroup analysis of ASA I-II patients also revealed a higher 90-day complication rate in patients with both CT characteristics (57.1 vs. 42.4%, p=0.007). Interestingly, patients with distended small bowels on CT-scan had a very high anastomotic leakage rate compared to the other groups, although not statistically significant when compared to group one (19.3 vs. 9.0%, p=0.062).
Conclusion
Patients presenting with LSOCC that have both a dilated cecum >9cm and a small bowel ileus seem to have a higher risk of complications and death following emergency surgery.
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