Towards optimizing care for complex colon cancer patients
Towards optimizing care for complex colon cancer patients
Colon cancer is one of the most common cancers worldwide. Some patients present with a more advanced or complicated form of the disease, known as complex colon cancer. This includes tumours that have grown into surrounding tissues, bowel obstruction, or infections caused by the tumour. These patients often have a higher risk of complications, cancer recurrence, and reduced survival, but there is still limited evidence to guide the best treatment.
This thesis of Bobby Zamaray aimed to improve our understanding of complex colon cancer by studying both its occurrence and the outcomes of different treatment strategies using nationwide data from the Netherlands.
The first part of this thesis showed that patients with tumour-related infections or perforations have substantially worse outcomes than patients with uncomplicated colon cancer. Different types of perforation were found to have different prognoses, highlighting the importance of distinguishing these conditions in both clinical practice and research. In addition, all forms of complex colon cancer were associated with a higher risk of cancer returning within the abdomen after surgery.
The second part focused on patients with left-sided obstructive colon cancer. More than one-third of these patients ultimately received a permanent stoma. Prediction models were developed to estimate an individual patient's risk, helping doctors and patients make more informed treatment decisions. Restoring bowel continuity during planned tumour surgery after initial decompression was shown to be safe and greatly reduced both the duration of stoma use and the likelihood of a permanent stoma. Furthermore, adjuvant chemotherapy improved survival in selected high-risk patients, particularly those with stage pT4N0 disease. Finally, despite guideline recommendations, self-expandable metal stents were used far less often than diverting stomas for palliative treatment, demonstrating an important gap between evidence-based recommendations and everyday clinical practice.
Overall, this thesis provides new evidence to improve the recognition and treatment of complex colon cancer and supports more personalized care for these patients.