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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 9/2011

01-09-2011 | Colorectal Cancer

Prognostic Significance of Preoperative Bowel Obstruction in Stage III Colorectal Cancer

Authors: Hiroshi Katoh, MD, PhD, Keishi Yamashita, MD, PhD, Guoqin Wang, MD, PhD, Takeo Sato, MD, Takatoshi Nakamura, MD, PhD, Masahiko Watanabe, MD, PhD, FACS

Published in: Annals of Surgical Oncology | Issue 9/2011

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Abstract

Background

Previous studies have suggested a detrimental prognostic effect of preoperative obstruction proximal to colorectal cancer (CRC). If such a detrimental effect is preserved in each stage of advanced (stage II or III) CRC, we can identify high-risk patients.

Methods

We enrolled 641 patients with pathologically confirmed advanced CRC (stage II, n = 207; stage III, n = 434) who had undergone curative resection of the primary lesion. The association of preoperative obstruction with clinicopathologic parameters was evaluated. Kaplan–Meier analysis and Cox proportional hazard models were used to estimate the effect of preoperative obstruction on disease-free survival in each stage.

Results

Preoperative obstruction was seen in 63 patients (9.8%) (stage II, n = 16; stage III, n = 47). Multivariable analysis showed that preoperative obstruction was significantly associated with preoperative elevation of carcinoembryonic antigen level in patients with colon cancer (odds ratio = 3.59; P < 0.001), while it was correlated with poor differentiation in patients with rectal cancer (odds ratio = 3.99; P = 0.016). Preoperative obstruction was a significant prognostic factor in stage III CRC (P < 0.001), but not in stage II disease. Multivariable prognostic analysis showed that preoperative obstruction was a remnant independent prognostic factor in stage III CRC. This finding was confirmed by separate analyses of colon and rectal cancer. Preoperative obstruction was associated with systemic recurrence (P = 0.003) rather than peritoneal or local recurrence.

Conclusions

These findings suggest that preoperative obstruction may predict worse long-term prognosis in patients with stage III CRC and may be a potential clinical marker to identify patients with high-risk stage III CRC.
Appendix
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Metadata
Title
Prognostic Significance of Preoperative Bowel Obstruction in Stage III Colorectal Cancer
Authors
Hiroshi Katoh, MD, PhD
Keishi Yamashita, MD, PhD
Guoqin Wang, MD, PhD
Takeo Sato, MD
Takatoshi Nakamura, MD, PhD
Masahiko Watanabe, MD, PhD, FACS
Publication date
01-09-2011
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 9/2011
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-011-1625-3

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