Acute PresentatiOn of coLorectaL cancer ‐ an internatiOnal snapshot (APOLLO): Protocol for a prospective, multicentre cohort study

Abstract

Aim The primary aim of the study is to describe the variation in the operative and nonoperative management of emergency presentations of colon and rectal cancer in an international cohort. Secondary aims will be to develop a risk prediction model for mortality and primary anastomosis and validate risk criteria of large bowel obstruction (LBO) in patients with previously known colorectal cancer undergoing neoadjuvant chemotherapy or awaiting elective surgery. Method This prospective, multicentre audit will be conducted via the student‐ and trainee‐led EuroSurg Collaborative network internationally over 2023 with 90‐day follow‐up. Data will be collected on consecutive adult patients presenting to the hospital in an unplanned and urgent manner with colorectal cancer (CRC) due to malignant LBO, perforation, CRC‐related haemorrhage, or other related reasons. Primary outcome is 90‐day mortality. Secondary outcomes include rates of stomas, primary anastomosis, stenting, preoperative imaging, and complications or readmissions. Conclusion This protocol describes the methodology for the first international audit on the management of acutely presenting CRC. This study will utilise a large collaborative network with robust data validation and assurance strategies. APOLLO will provide a comprehensive understanding of current practice, develop risk prediction tools in this setting, and validate existing trial results.

Management of obstructed colorectal carcinoma in an emergency setting: An update

“…For right-sided curable obstruction, a therapeutic surgical intervention is indicated in most cases[ 18 ]. For left-sided obstruction, various choices exist, including curative resection accompanied or not accompanied by primary anastomosis, endoscopic stent placement usually or drainage placement, and diverting stoma formation[ 15 , 22 , 24 , 57 ]. It should be individualized in most cases[ 23 ] and according to a reliable scoring system[ 58 ].…”

“…It is a potentially fatal condition that requires emergency intestinal decompression[ 3 , 13 ], and various models that predict the risk of mortality have been developed[ 14 ]. On the other hand, obstruction is the most common cause (75%-80%) of presentation to the emergency department among patients with colorectal carcinoma[ 15 ]. Younger age (under 50 years), males, and those with ascending colon obstruction have a greater possibility of presenting to the emergency department for care[ 3 , 8 ].…”

“…The onset is characterized by suspension of gas and feces, abdominal distension, deep pain or fullness, and nausea or possible vomiting. Vomiting is more apparent and earlier on the right side, while the distention is more obvious on the left side[ 15 ].…”