Stenting as a bridge to surgery in obstructing colon cancer: Long-term recurrence pattern and competing risk of mortality

Aik Yong Chok; Yun Zhao; Hui Jun Lim; Yvonne Ying Ru Ng; Emile John Kwong Wei Tan

doi:10.4253/wjge.v15.i2.64

Stenting as a bridge to surgery in obstructing colon cancer: Long-term recurrence pattern and competing risk of mortality

World J Gastrointest Endosc. 2023 Feb 16;15(2):64-76. doi: 10.4253/wjge.v15.i2.64.

Authors

Aik Yong Chok¹, Yun Zhao^{2

3}, Hui Jun Lim², Yvonne Ying Ru Ng², Emile John Kwong Wei Tan²

Affiliations

¹ Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore. chokaikyong@gmail.com.
² Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore.
³ Department of Group Analytics, Singapore Health Services, Singapore 168582, Singapore.

Abstract

Background: Stenting as a bridge to curative surgery (SBTS) for obstructing colon cancer (OCC) has been associated with possibly worse oncological outcomes.

Aim: To evaluate the recurrence patterns, survival outcomes, and colorectal cancer (CRC)-specific death in patients undergoing SBTS for OCC.

Methods: Data from 62 patients undergoing SBTS at a single tertiary centre over ten years between 2007 and 2016 were retrospectively examined. Primary outcomes were recurrence patterns, overall survival (OS), cancer-specific survival (CSS), and CRC-specific death. OS and CSS were estimated using the Kaplan-Meier curves. Competing risk analysis with cumulative incidence function (CIF) was used to estimate CRC-specific mortality with other cause-specific death as a competing event. Fine-Gray regressions were performed to determine prognostic factors of CRC-specific death. Univariate and multivariate subdistribution hazard ratios and their corresponding Wald test P values were calculated.

Results: 28 patients (45.2%) developed metastases after a median period of 16 mo. Among the 18 patients with single-site metastases: Four had lung-only metastases (14.3%), four had liver-only metastases (14.3%), and 10 had peritoneum-only metastases (35.7%), while 10 patients had two or more sites of metastatic disease (35.7%). The peritoneum was the most prevalent (60.7%) site of metastatic involvement (17/28). The median follow-up duration was 46 mo. 26 (41.9%) of the 62 patients died, of which 16 (61.5%) were CRC-specific deaths and 10 (38.5%) were deaths owing to other causes. The 1-, 3-, and 5-year OS probabilities were 88%, 74%, and 59%; 1-, 3-, and 5-year CSS probabilities were 97%, 83%, and 67%. The highest CIF for CRC-specific death at 60 mo was liver-only recurrence (0.69). Liver-only recurrence, peritoneum-only recurrence, and two or more recurrence sites were predictive of CRC-specific death.

Conclusion: The peritoneum was the most common metastatic site among patients undergoing SBTS. Liver-only recurrence, peritoneum-only recurrence, and two or more recurrence sites were predictors of CRC-specific death.

Keywords: Colorectal cancer; Competing risk analysis; Endoscopic stenting; Obstructing colon cancer; Peritoneal metastasis; Recurrence; Survival.