Relief of Obstruction in Left-Sided Obstructive Colon Cancer: Nationwide Analysis of Applied Treatment in the Palliative Setting.

BACKGROUND: For relief of bowel obstruction in left-sided obstructive colon cancer (LSOCC), a self-expandable metal stent (SEMS) or decompressing stoma (DS) can be placed. In a curative setting, these two strategies have been extensively studied as a bridge to elective resection. Guidelines recommend SEMS as the preferred option in the palliative setting, but adherence in daily practice is unknown. Therefore, this study aimed to gain more insight into patients with LSOCC who received palliative treatment with SEMS or DS at a national level. METHODS: A retrospective population-based cohort study was conducted in the Netherlands. Data from the Netherlands Cancer Registry (NCR) on all patients with LSOCC treated with DS or SEMS not followed by resection of the primary tumour between January 1, 2015, and December 31, 2019, were analysed. Type of treatment (DS or SEMS) for different clinical scenarios, was the main outcome of this study, and was also evaluated over the years (2015-2019). RESULTS: Palliative treatment with SEMS or DS for LSOCC was performed in 1077 patients, of whom 79.2% had metastatic disease (M1). Patients without metastatic disease (M0) were older (≥ 80 years M0 67.4%, M1 25.3%, P < 0.001), had a worse clinical condition (ASA III 51.4% versus 36.37%, ASA IV-V 13.3% versus 4.0% P < 0.001) and presented with higher tumour stage (cT4 55.4% versus 33.5%, % P < 0.001). DS was performed in 91.5% of the patients and SEMS in 8.5%. The proportion of DS did not significantly differ between patients with M1 and M0 (91.8% vs. 90.2% respectively, P = 0.525). No increase in SEMS application was observed over the years, with a stable overall proportion of DS of 91-92% per year. In the multivariable analyses, ninety-day mortality and overall survival were not significantly different between SEMS and DS. CONCLUSIONS: This study revealed that DS was the primary treatment modality for palliative management of LSOCC in the Netherlands between 2015 and 2019, while the guidelines recommended SEMS as preferred treatment. For patients with LSOCC eligible for stenting in the palliative setting, SEMS placement should become more available and accessible as the preferred treatment option, to avoid a stoma in the terminal phase of life.

CT texture analysis in colorectal liver metastases and the surrounding liver parenchyma and its potential as an imaging biomarker of disease aggressiveness, response and survival.

OBJECTIVES: To study the ratio between the CT texture of colorectal liver metastases (CRLM) and the surrounding liver parenchyma and assess the potential of various texture measures and ratios as predictive/prognostic imaging markers. MATERIALS: Seventy patients with colorectal cancer and synchronous CRLM were included. All visible metastases, as well as the whole-volume of the surrounding liver, were separately delineated on the portal venous phase primary staging CT. Texture features entropy (E) and uniformity (U) were extracted and ratios between the texture features (T) of the metastases and background liver (Tmetastases/Tliver) calculated. Texture features were compared with clinical outcome parameters: [1] extent of disease (i.e. number of metastases), [2] response to chemotherapy (in 56/70 patients who underwent chemotherapy and CT for response evaluation), and [3] overall survival. RESULTS: The Emetastases/Eliver ratio was lower in patients with limited disease (P = 0.02) and associated with overall survival, albeit not statistically significant when tested in multivariable analyses (HR 1.90; P = 0.07); Umetastases/Uliver was higher in patients with limited disease (P = 0.02). Emetastases showed a trend towards a higher value in patients that responded well to chemotherapy (P = 0.08). CONCLUSION: The ratio between the texture of liver metastases and the surrounding liver appears to reflect relevant changes in tissue microarchitecture and may be of value to assess the extent of disease and help predict overall survival.