Completion of preoperative chemotherapy and surgical outcome in patients with stenotic colon cancer without obstruction: A cohort study.

Abstract

Current evidence has shown an oncologic benefit of preoperative chemotherapy for patients with locally advanced and metastatic colon cancer. However, some patients present with stenosis that blocks the colonoscope but without symptomatic obstruction. Whether the stenosis will progress to obstruction during chemotherapy is unknown, and this uncertainty may encourage unnecessary diversion or stenting, or impede optimal treatment. We retrospectively analyzed 465 consecutive patients with endoscopically stenotic colon cancer without symptomatic obstruction in a quaternary referral center from 2013 to 2020. Patients were grouped into upfront surgery (361) and preoperative chemotherapy (104). Clinical courses of patients receiving preoperative chemotherapy were described, with expedited surgery as the primary outcome. Obstruction or perforation occurred in 25 of 104 (24.0%) patients receiving preoperative chemotherapy, of which 11 discontinued chemotherapy and received expedited surgery, and 14 resumed chemotherapy after stent or medical treatment. In total, 93 (89.4%) patients received elective surgery after preoperative chemotherapy. In addition, the preoperative chemotherapy group demonstrated a 41.3% objective response rate. Three of 4 patients with stenotic colon cancer without symptomatic obstruction can complete preoperative chemotherapy uneventfully. Expedited surgery was needed in 10.6% because of obstruction or perforation during chemotherapy.