Long-term outcomes after postponing surgery to optimise patients with acute right-sided obstructing colon cancer

To retrospectively analyse the short- and long-term oncological, morbidity and mortality outcomes in patients diagnosed with acute right-sided obstructing colon cancer. Patients who underwent pre-optimisation prior to the oncological resection were compared to patients who did not undergo pre-optimisation.

All consecutive patients with right-sided obstructing colon cancer, either with a high clinical suspicion or confirmed diagnosis by histological analysis, who underwent curative-intent treatment between March 2013 and December 2020 were included. Patients were divided into two groups: an optimised group and a non-optimised group. Preoperative optimisation included additional nutrition, physiotherapy, and, if needed, bowel decompression. Data about disease-free survival and mortality were collected up to three years after surgery.

Sixty-two patients were included. Thirty patients underwent the optimisation protocol before postponed surgery, and 32 patients received emergency surgery, without optimisation (surgery performed with a median of 9.6 days versus 22 h after admission). The postoperative complication rate was significantly lower in the optimisation group (50 % vs 78 %, p = 0.033). No significant differences were found in the 90-day mortality rate (7 % vs 13 %, p = 0.672) and three-year overall survival rate (43 % vs 56 %, p = 0.49). After three years, sixteen (53 %) patients in the optimised group and twenty (63 %) in the non-optimised were deceased (p = 0.672).

Postponing the surgery with preoperative optimisation in patients with obstructing right-sided colon cancer results in a significantly lower 90-day complication rate and suggests no negative effect on survival rates compared to an acute resection. Although, further research with a larger sample size is needed.