APOLLO (Acute PresentatiOn of CoLorectaL Cancer: an internatiOnal snapshot) is an international, multi-centre, prospective observational study which will address this need and aims to describe the operative and non-operative management of emergency presentations of colon and rectal cancer in an international cohort.
Primary aim: Describe the variation in the operative and non-operative management of emergency presentations of colon and rectal cancer in an international cohort. Secondary aims: * Identify risk factors for mortality (intraoperatively, at 30-days and at 90-days) and ostomy rates (at 30- and 90-days) in patients deemed for active management (i.e., not for palliative management) to develop a risk prediction model * Validate risk criteria of large bowel obstruction in patients with previously known colorectal cancer undergoing neoadjuvant chemotherapy or awaiting elective surgery Who? * Patients aged 18 years and above presenting to the hospital acutely with colorectal cancer (CRC) for malignant large bowel obstruction (LBO), perforation, CRC-related haemorrhage or other reasons within the data collection periods. Both those managed with and without surgery will be included * Patients with localised and metastatic disease will be included * Patients with known colorectal cancer diagnoses will be included if they present acutely (e.g., with disease progression) * Patients presenting acutely for the side effects of chemotherapy/radiotherapy of known cancers will be excluded What? Data will be collected on patients' presenting status and symptoms, patient management strategies, and intraoperative and postoperative outcomes. When? Prospectively over 2023 in consecutive 6-week data collection blocks between January and June with 90-day follow-up till September.
Study Type
OBSERVATIONAL
Enrollment
2,000
Aberdeen Royal Infirmary
Aberdeen, Ireland, United Kingdom
Primary outcome
Mortality since day of presentation
Time frame: 90-day
Secondary outcome 1
Inpatient mortality, mortality since day of presentation
Time frame: 30-day
Secondary outcome 2
Operative mortality rates
Time frame: 30- and 90-day
Secondary outcome 3
Rates of primary anastomosis
Time frame: 30- and 90-day
Secondary outcome 4
Stoma formation and reversal rates
Time frame: 30- and 90-day
Secondary outcome 5
Rate and grade of surgical complications
Time frame: 90-day
Secondary outcome 6
Rates of stenting in those with left-sided LBO, rates of stenting in those treated with palliative intent, rate of colonic stenting complications
Time frame: 30- and 90-day
Secondary outcome 7
Rate of representation for patients managed nonoperatively
Time frame: 30- and 90-day
Secondary outcome8
Rates of radiological assessment on admission
Time frame: 30- and 90-day
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Secondary outcome 9
Proportion of patients presenting acutely with large bowel obstruction with known colorectal cancer who had high risk criteria for obstruction (as defined by the FOXTroT obstruction criteria) at index assessment
Time frame: 30- and 90-day