Nuri OKKABAZ, Demet SARIDEMİR, Mustafa Saraçoğlu, Okan ERDOĞAN

Tıkayıcı Kolorektal Kanserlerde Cerrahi Strateji ve Lenf Nodu Oranının Sonuçlar ve Prognoz Üzerine Etkisi

GİRİŞ ve AMAÇ: Tıkayıcı kolorektal kanserlerde kısa ve uzun dönem sonuçların değerlendirmesi ve lenf nodu oranının prognostik öneminin ortaya konması amaçlanmıştır. YÖNTEM ve GEREÇLER: Ocak 2001-Eylül 2007 tarihleri arasında tıkayıcı kolorektal kanser nedeniyle acil şartlarda ameliyat edilen hastalar geriye dönük olarak derlenmiştir. Cerrahi sonuçlar ve sağkalım değerlendirilmiş olup ortanca lenf nodu oranına göre gruplar arasında genel ve hastalıksız sağkalım karşılaştırmaları yapılmıştır BULGULAR: Toplam 64 hasta [erkek (n=33, %51,6), ortanca yaş: 68,5] hasta derlendi. Ortanca lenf nodu oranı 0.09 idi. Proksimal ve distal tümörlerde perioperatif morbidite, mortalite ve küratif rezeksiyon oranları farklı değildi. Beş yıllık genel sağkalım %34,4, ortanca sağkalım süresi 19 ay olarak bulundu. Proksimal ve dital tümörler ile erken ve ilere evre tümörlerde genel sağkalım ve hastalıksız sağkalım istatistiksel olarak farklı değildi (p>0.05). Ortanca lenf nodu oranına göre gruplar arasında genel sağkalım ve hastalıksız sağkalım açısından istatistiksel anlamlı farklılık yoktu (p>0.05). TARTIŞMA ve SONUÇ: Tıkayıcı distal kolorektal kanserlerde cerrahi stratejiye karar verirken daha objektir kriterler kullanılmalıdır. Tıkayıcı kolorektal kanseri olan hastalarda prognoz kötü olmasına rağmen, küratif rezeksiyon yapılan ve perioperatif komplikasyonları atlatan hastalar daha iyi uzun dönem sonuçlara sahiptir. Ortanca lenf nodu oranı tıkayıcı kolorektal kanserlerde prognostik anlam göstermemiştir.

Surgical Strategies and Prognostic Significance of Lymph Node Ratio in Obstructive Colorectal Cancers

INTRODUCTION: To investigate the effect of preoperativeobstruction in patients with colorectal cancer (CRC) on short and long-term outcomes and to find out the prognostic significance of lymph node ratio (LNR).METHODS: This retrospective study included patientsoperated for obstructive CRC under emergency conditions.Surgical outcomes and survival analysis were evaluated in allcohorts. Overall survival (OS) and disease free survival (DFS)rates were compared between patient groups according tomedian LNR value.RESULTS: A total of 64 patients [male (n=33, 51.6%), median age: 68.5 years] were retrieved. Median LNR was calculated as 0.09. Perioperative morbidity and mortality and curative resection rates were not different between patients with proximal and distal tumors. 5-year OS rate and median survival for all patients were 34.4% and 19 months, respectively. OS and DFS did not significantly differ between patients in early and advanced stage disease and with proximal and distal tumors (p>0.05). OS and DFS did not show significant difference in patient groups according to median cut-off LNR value (p>0.05).DISCUSSION and CONCLUSION: More objective criteria should be used while deciding on surgical strategy for obstructive distal CRCs. Although obstruction is associated with poor overall prognosis, patients who have curative resection and survive from perioperative complications have favorable long-term results. Median LNR did not show any prognostic significance for obstructive CRCs.

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1. Katoh H, Yamashita K, Wang G, Sato T, Nakamura T, Watanabe M. Prognostic significance of preoperative bowel obstruction in stage III colorectal cancer. Ann Surg Oncol 2011;18:2432-41.
2. Cuffy M, Abir F, Audisio RA, Longo WE. Colorectal cancer presenting as surgical emergencies. Surg Oncol 2004;13:149-57.
3. Alvarez JA, Baldonedo RF, Bear IG, Truán N, Pire G, Alvarez P. Presentation, treatment, and multivariate analysis of risk factors for obstructive and perforative colorectal carcinoma. Am J Surg 2005;190:376-82.
4. Hsu TC. Comparison of one-stage resection and anastomosis of acute complete obstruction of left and right colon. Am J Surg 2005;189:384-7.
5. Baxter NN, Virnig DJ, Rothenberger DA, Morris AM, Jessurun J, Virnig BA. Lymph node evaluation in colorectal cancer patients: a population-based study. J Natl Cancer Inst 2005;97:219-25.
6. Hong, KD, Lee SI, Moon HY. Lymph node ratio as determined by the 7th edition of the American Joint Committee on Cancer staging system predicts survival in stage III colon cancer. J Surg Oncol 2011;103:406-10.
7. Petrelli, F, Borgonovo K, Barni S. The emerging issue of ratio of metastatic to resected lymph nodes in gastrointestinal cancers: an overview of literature. Eur J Surg Oncol 2011;37:836-47.
8. Qiu HB, Zhang LY, Li YF, Zhou ZW, Keshari RP, Xu RH. Ratio of metastatic to resected lymph nodes enhances to predict 9. survival in patients with stage III colorectal cancer. Ann Surg Oncol 2011;18:1568-74.
10. Berger AC, Sigurdson ER, LeVoyer T, Hanlon A, Mayer RJ, Macdonald JS, et al. Colon cancer survival is associated with decreasing ratio of metastatic to examined lymph nodes. J Clin Oncol 2005;23:8706-12.
11. Frago R, Biondo S, Millan M, Kreisler E, Golda T, Fraccalvieri D, et al. Differences between proximal and distal obstructing colonic cancer after curative surgery. Colorectal Dis 2011;13:116-22.
12. Wang HS, Lin JK, Mou CY, Lin TC, Chen WS, Jiang JK, et al. Long-term prognosis of patients with obstructing carcinoma of the right colon. Am J Surg 2004;187:497-500.
13. Jestin P, Nilsson J, Heurgren M, Påhlman L, Glimelius B, Gunnarsson U. Emergency surgery for colonic cancer in a defined population. Br J Surg 2005;92:94-100.
14. Tas F, Keskin S. Age-specific incidence ratios of colorectal cancer (CRC) in Turkey: CRC in older people is increasing. Arch Gerontol Geriatr 2012;55:279-82.
15. McArdle CS, Hole DJ. Emergency presentation of colorectal cancer is associated with poor 5-year survival. Br J Surg 2004;91:605-9.
16. Lee YM, Law WL, Chu KW, Poon RT. Emergency surgery for obstructing colorectal cancers: a comparison between right-sided and left-sided lesions. J Am Coll Surg 2001;192:719-25.
17. Yeo HL, SW Lee. Colorectal emergencies: review and controversies in the management of large bowel obstruction. J Gastrointest Surg 2013;17:2007-12.
18. Zorcolo L, Covotta L, Carlomagno N, Bartolo DC. Safety of primary anastomosis in emergency colo-rectal surgery. Colorectal Dis 2003;5:262-9.
19. Cho YB, Yun SH, Hong JS, Yun HR, Lee WS, Lee WY, et al. Carcinoma obstruction of the left colon and long-term prognosis. Hepatogastroenterology 2008;55:1288-92.
20. Chin CC, Wang JY, Changchien CR, Huang WS, Tang R. Carcinoma obstruction of the proximal colon cancer and long-term prognosis--obstruction is a predictor of worse outcome in TNM stage II tumor. Int J Colorectal Dis 2010;25:817-22.
21. Yang Z, Wang L, Kang L, Xiang J, Peng J, Cui J, et al. Clinicopathologic characteristics and outcomes of patients with obstructive colorectal cancer. J Gastrointest Surg 2011;15:1213-22.
22. Aslar AK, Ozdemir S, Mahmoudi H, Kuzu MA. Analysis of 230 cases of emergent surgery for obstructing colon cancer--lessons learned. J Gastrointest Surg 2011;15:110-9.
23. The Association of Coloproctology of Great Britain & Ireland at The Royal College of Surgeons of England. Guidelines for the management of colorectal cancer ;2007 [Citer 2014 November 14] Available from http://www.acpgbi.org.uk/resources/guidelin es/guidelines-for-the-management-ofcolorectal-cancer.
24. Tentes AA, Mirelis CG, Kakoliris S, Korakianitis OS, Bougioukas IG, Tsalkidou EG, et al. Results of surgery for colorectal carcinoma with obstruction. Langenbecks Arch Surg 2009;394:49-53.
25. Rosenberg R, Friederichs J, Schuster T, Gertler R, Maak M, Becker K, et al. Prognosis of patients with colorectal cancer is associated with lymph node ratio: a singlecenter analysis of 3,026 patients over a 25- year time period. Ann Surg 2008;248:968- 78.
26. Ceelen W, Van Nieuwenhove Y, Pattyn P. Prognostic value of the lymph node ratio in stage III colorectal cancer: a systematic review. Ann Surg Oncol 2010;17:2847-55.
27. Wang J, Kulaylat M, Rockette H, Hassett J, Rajput A, Dunn KB, et al. Should total number of lymph nodes be used as a quality of care measure for stage III colon cancer? Ann Surg 2009;249:559-63.
28. Huh JW, Kim CH, Kim HR, Kim YJ. Factors predicting oncologic outcomes in patients with fewer than 12 lymph nodes retrieved after curative resection for colon cancer. J Surg Oncol 2012;105:125-9.
29. Peng J, Xu Y, Guan Z, Zhu J, Wang M, Cai G, et al. Prognostic significance of the metastatic lymph node ratio in node-positive rectal cancer. Ann Surg Oncol 2008;15:3118-23.
30. Lee HY, Choi HJ, Park KJ, Park KJ, Shin JS, Kwon HC, et al. Prognostic significance of metastatic lymph node ratio in node-positive colon carcinoma. Ann Surg Oncol 2007;14:1712-7.
31. Schumacher P, Dineen S, Barnett C Jr, Fleming J, Anthony T. The metastatic lymph node ratio predicts survival in colon cancer. Am J Surg 2007;194:827-31.