대장암에서 폐색이 예후에 미치는 영향 = The Prognostic Impact of Obstructed Colorectal Cancer

다국어 초록 (Multilingual Abstract)

Purpose: An obstructed colorectal cancer (OB) has a
poorer survival than a non-obstructed cancer (NOB). This
study examined the prognostic impact of bowel obstruction
on colorectal cancer. Methods: From December
1999 to December 2005, patients undergoing single stage
operation for OB were examined prospectively. OB (n=
193) was compared with a NOB (n=444) used in a
primary tumor resection during the same period. 637
colorectal cancers were examined in this study. Results:
The overall operative mortality was 21 (3.3%) and the
postoperative mortality was significantly higher in the OB
(OB: 16, 8.3%) group than in the NOB (NOB: 5, 1.1%)
group. The proportion of OB was higher in the left-colon
(52.8%) than in the right colon (16.0%) and rectum
(31.1%, P＜0.001). However, OB was associated with
an older age (P=0.013). The proportion of advanced
tumor stage was higher in OB (II: 35.8%, III: 39.5%, IV:
24.7%) than in NOB (II: 53.2%, III: 35.8%, IV: 11.0%,
P＜0.001). The 5-year cancer-related survival for OB was
worse than NOB (OB: 77.3%, NOB: 57.8%, P＜0.05).
However, in the cases of a colorectal cancer performed
curative resection (stage II and III), the survival for OB
was not worse than NOB: stage II (OB: 82.8%, NOB:
92.2%, P=0.24), stage III (OB: 65.2%, NOB: 56.9%,
P=0.43). Conclusions: OB has older and more advanced
disease characteristics. However, if an oncologically
curative resection is performed, the survival for OB is
similar to that of a NOB.

다국어 초록 (Multilingual Abstract)

Purpose: An obstructed colorectal cancer (OB) has a
poorer survival than a non-obstructed cancer (NOB). This
study examined the prognostic impact of bowel obstruction
on colorectal cancer. Methods: From December
1999 to December 2005, patients undergoing single stage
operation for OB were examined prospectively. OB (n=
193) was compared with a NOB (n=444) used in a
primary tumor resection during the same period. 637
colorectal cancers were examined in this study. Results:
The overall operative mortality was 21 (3.3%) and the
postoperative mortality was significantly higher in the OB
(OB: 16, 8.3%) group than in the NOB (NOB: 5, 1.1%)
group. The proportion of OB was higher in the left-colon
(52.8%) than in the right colon (16.0%) and rectum
(31.1%, P＜0.001). However, OB was associated with
an older age (P=0.013). The proportion of advanced
tumor stage was higher in OB (II: 35.8%, III: 39.5%, IV:
24.7%) than in NOB (II: 53.2%, III: 35.8%, IV: 11.0%,
P＜0.001). The 5-year cancer-related survival for OB was
worse than NOB (OB: 77.3%, NOB: 57.8%, P＜0.05).
However, in the cases of a colorectal cancer performed
curative resection (stage II and III), the survival for OB
was not worse than NOB: stage II (OB: 82.8%, NOB:
92.2%, P=0.24), stage III (OB: 65.2%, NOB: 56.9%,
P=0.43). Conclusions: OB has older and more advanced
disease characteristics. However, if an oncologically
curative resection is performed, the survival for OB is
similar to that of a NOB.

참고문헌 (Reference)

1 Stower MJ, "The results of 1115 patients with colorectal cancer treated over an 8-year period in a single hospital" 11 : 119-123, 1985

2 Wolmark N, "The prognostic significance of tumor location and bowel obstruction in Dukes B and C colorectal cancer. Findings from the NSABP clinical trials" 198 : 743-752, 1983

3 McArdle CS, "The impact of blood loss, obstruction and perforation on survival in patients undergoing curative resection for colon cancer" 93 : 483-488, 2006

4 Villar JM, "Surgical options for malignant left-sided colonic obstruction" 35 : 275-281, 2005

5 Single-stage treatment for malignant lef, "Subtotal Colectomy versus On-table Irrigation and Anastomosis" The SCOTIA Study Group 82 : 1622-1627, 1995

6 Steinberg SM, "Stablein DM. Prognostic indicators of colon tumors. The Gastrointestinal Tumor Study Group experience" 57 : 1866-1870, 1986

7 Park UC, "Single-stage procedure with intraoperative colonoscopy and colonic irrigation in patients with obstructing left-sided colonic cancer" 19 : 487-492, 2004

8 Watt AM, "Self-expanding metallic stents for relieving malignant colorectal obstruction: a systematic review" 246 : 24-30, 2007

9 Deen KI, "Rothenberger DA. Surgical management of left colon obstruction: the University of Minnesota experience" 187 : 573-576, 1998

10 Scott NA, "Risk factors in patients presenting as an emergency with colorectal cancer" 82 : 321-323, 1995

11 Chen HS, "Obstruction and perforation in colorectal adenocarcinoma: an analysis of prognosis and current trends" 127 : 370-376, 2000

12 Garcia-Valdecasas JC, "Obstructing colorectal carcinomas. Prospective study" 34 : 759-762, 1991

13 Serpell JW, "Obstructing carcinomas of the colon" 76 : 965-969, 1989

14 Borie F, "Management and prognosis of colon cancer in patients with intestinal obstruction or peritonitis: a French population-based study" 11 : 266-273, 2005

15 Phillips RK, "Malignant large bowel obstruction" 72 : 296-302, 1985

16 Biondo S, "Large bowel obstruction: predictive factors for postoperative mortality" 47 : 1889-1897, 2004

17 Runkel NS, "Improved outcome after emergency surgery for cancer of the large intestine" 85 : 1260-1265, 1998

18 Lee YM, "Emergency surgery for obstructing colorectal cancers: a comparison between right-sided and left-sided lesions" 192 : 719-725, 2001

19 Jestin P, "Emergency surgery for colonic cancer in a defined population" 92 : 94-100, 2005

20 Papanicolaou G, "Effect of large-bowel obstruction on colonic blood flow. An experimental study" 32 : 673-679, 1989

21 Kim JH, "Complete single-stage management of left colon cancer obstruction with a new device" 19 : 1381-1387, 2005

22 Kim JH, "Complete single stage management of left colon cancer with a new devices" 18 : 30-36, 2002

23 Kronborg O, "Acute obstruction in cancer of the colon and rectum" 18 : 22-27, 1975

24 Biondo S, "A prospective study of outcomes of emergency and elective surgeries for complicated colonic cancer" 189 : 377-383, 2005