Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Feb 16, 2023; 15(2): 64-76
Published online Feb 16, 2023. 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
Aik Yong Chok, Yun Zhao, Hui Jun Lim, Yvonne Ying Ru Ng, Emile John Kwong Wei Tan
Aik Yong Chok, Yun Zhao, Hui Jun Lim, Yvonne Ying Ru Ng, Emile John Kwong Wei Tan, Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore
Yun Zhao, Department of Group Analytics, Singapore Health Services, Singapore 168582, Singapore
Author contributions: Chok AY and Tan EJKW designed the study and interpreted the data; Zhao Y performed the analysis and visualisation; Lim HJ and Ng YYR performed the literature review and clinical data collection; Chok AY, Zhao Y and Lim HJ drafted the manuscript; Chok AY, Zhao Y and Ng YYR edited the manuscript; Chok AY and Tan EJKW provided critical revision for final approval; all authors have read and approved the final version of the manuscript.
Institutional review board statement: This study was approved by Singapore Health Services (SingHealth) Institutional Review Board (IRB Ref. 2017/2481). All methods were carried out in accordance with relevant guidelines and regulations (Declaration of Helsinki).
Informed consent statement: Due to the study’s retrospective design using de-identified data, written informed consent collection was waived by SingHealth Centralised Institutional Review Board.
Conflict-of-interest statement: All authors declare that they have no relevant or material financial interests that relate to the research described in this paper.
Data sharing statement: The data that support the findings of this study are available on request from the corresponding author at chokaikyong@gmail.com. The data are not publicly available due to privacy or ethical restrictions.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Aik Yong Chok, FRCS (Ed), MBBS, MMed, Surgeon, Department of Colorectal Surgery, Singapore General Hospital, 20 College Road, Singapore 169608, Singapore. chokaikyong@gmail.com
Received: November 29, 2022
Peer-review started: November 29, 2022
First decision: December 19, 2022
Revised: December 28, 2022
Accepted: January 9, 2023
Article in press: January 9, 2023
Published online: February 16, 2023
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: Obstructing colon cancer, Colorectal cancer, Endoscopic stenting, Competing risk analysis, Survival, Recurrence, Peritoneal metastasis

Core Tip: This is the first retrospective study with a 10-year period using the competing risk analysis of cumulative incidence function to evaluate survival and estimate colorectal cancer (CRC)-specific death based on the Fine-Gray model in patients undergoing stenting as a bridge to curative surgery (SBTS) for obstructing colon cancer (OCC). The duration of this study allows a thorough examination of the long-term oncological outcomes of SBTS, survival rates, recurrence patterns, and prognostic factors contributing to CRC-specific death. Our results showed that liver-only recurrence, peritoneum-only recurrence, and more than two recurrence sites are significantly associated with poor survival and prognostic factors for CRC-specific death in patients undergoing SBTS for OCC.