Published online Sep 7, 2019. doi: 10.3748/wjg.v25.i33.4970
Peer-review started: April 29, 2019
First decision: May 30, 2019
Revised: June 9, 2019
Accepted: July 19, 2019
Article in press: July 19, 2019
Published online: September 7, 2019
Obstructive colorectal cancer (OCC) presenting with acute abdominal symptoms is always accompanied by severe complications, and the optimal strategy for patients with OCCs remains undetermined. Emergency surgery (ES) and self-expandable metal stents (SEMS) as a bridge to surgery (BTS) were the major treatments for OCCs, however, the indications remain debated. According to different status of immunology and nutrition, predictive factors for prognosis might be different between the two groups. Preoperative inflammation indexes might favor patient selection in terms of the prognosis of OCC.
Weighing the waxes and wanes of ES and BTS, both acute and chronic inflammation responses should be accounted for the selection of optimal patients.
This study was designed to build an inflammatory model for the surgical indications for ES and BTS in OCC.
This was a retrospective study in which 128 patients who underwent surgery for OCC at the Department of Emergency Surgery of Fujian Medical University Union Hospital from January 2008 to October 2015 were included in this study. Patients were divided into an ES group and a BTS group according to the surgeon’ advises and patients’ selection. Inflammation indexes were fully evaluated in this study.
Comparable survival outcomes were observed between the ES and BTS groups. Receiver operating characteristic curve analysis showed dNLR as the optimal biomarker for the prediction of DFS in ES, by contrast, LMR was recommended for BTS with regard to OS and DFS. dNLR was related to stoma construction, postoperative pneumonia, and DFS in the ES group. LMR was closely related to lymph nodes invasion, OS, and DFS in the BTS group. LMR could differentiate OS between the ES and BTS groups. A low LMR (< 1.67) was correlated with a low incidence of death and tumor recurrence in the BTS group.
As a supplement for the latest ESGE guidelines, the indications for the use of SEMSs in OCC might elaborate to patients with low preoperative LMR, who would benefit from BTS via SEMS insertion.