Colon sparing resection versus extended colectomy for left-sided obstructing colon cancer with caecal ischaemia or perforation: a nationwide study from the French Surgical Association.
Obstructing colonic cancer
caecal ischaemia
diastatic caecal perforation
left colon cancer
surgery
Journal
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland
ISSN: 1463-1318
Titre abrégé: Colorectal Dis
Pays: England
ID NLM: 100883611
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
14
01
2020
accepted:
02
04
2020
pubmed:
6
5
2020
medline:
19
8
2021
entrez:
6
5
2020
Statut:
ppublish
Résumé
It is not known whether patients with obstructive left colon cancer (OLCC) with caecal ischaemia or diastatic perforation (defined as a blowout of the caecal wall related to colonic overdistension) should undergo a (sub)total colectomy (STC) or an ileo-caecal resection with double-barrelled ileo-colostomy. We aimed to compare the results of these two strategies. From 2000 to 2015, 1220 patients with OLCC underwent surgery by clinicians who were members of the French Surgical Association. Of these cases, 201 (16%) were found to have caecal ischaemia or diastatic perforation intra-operatively: 174 patients (87%) underwent a STC (extended colectomy group) and 27 (13%) an ileo-caecal resection with double-end stoma (colon-sparing group). Outcomes were compared retrospectively. In the extended colectomy group, 95 patients (55%) had primary anastomosis and 79 (45%) had a STC with an end ileostomy. In the colon-sparing group, 10 patients (37%) had simultaneous resection of their primary tumour with segmental colectomy and an anastomosis which was protected by a double-barrelled ileo-colostomy. The demographic data for the two groups were comparable. Median operative time was longer in the STC group (P = 0.0044). There was a decrease in postoperative mortality (7% vs 12%, P = 0.75) and overall morbidity (56% vs 67%, P = 0.37) including surgical (30% vs 40%, P = 0.29) and severe complications (17% vs 27%, P = 0.29) in the colon-sparing group, although these differences did not reach statistical significance. Cumulative morbidity included all surgical stages and the rate of permanent stoma was 66% and 37%, respectively, with no significant difference between the two groups. Overall survival and disease-free survival were similar between the two groups. The colon-sparing strategy may represent a valid and safe alternative to STC in OLCC patients with caecal ischaemia or diastatic perforation.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1304-1313Investigateurs
J M Regimbeau
(JM)
V Bridoux
(V)
A Venara
(A)
L Beyer-Berjot
(L)
T Codjia
(T)
M Dazza
(M)
G Gagnat
(G)
S Hamel
(S)
L Mallet
(L)
P Martre
(P)
G Philouze
(G)
E Roussel
(E)
P Tortajada
(P)
A S Dumaine
(AS)
B Heyd
(B)
B Paquette
(B)
F Brunetti
(F)
F Esposito
(F)
V Lizzi
(V)
N Michot
(N)
Q Denost
(Q)
E Rullier
(E)
C Tresallet
(C)
O Tetard
(O)
P Rivier
(P)
E Fayssal
(E)
M Collard
(M)
D Moszkowicz
(D)
R Lupinacci
(R)
F Peschaud
(F)
J C Etienne
(JC)
L Loge
(L)
T Bege
(T)
H Corte
(H)
E D'Annunzio
(E)
M Humeau
(M)
J Issard
(J)
N Munoz
(N)
J Abba
(J)
Y Jafar
(Y)
L Lacaze
(L)
P Y Sage
(PY)
L Susoko
(L)
B Trilling
(B)
C Arvieux
(C)
F Mauvais
(F)
B Ulloa-Severino
(B)
S Pitel
(S)
A Vauchaussade de Chaumont
(A)
B Badic
(B)
B Blanc
(B)
M Bert
(M)
P Rat
(P)
P Ortega-Deballon
(P)
A Chau
(A)
C Dejeante
(C)
G Piessen
(G)
E Grégoire
(E)
A Alfarai
(A)
M Cabau
(M)
A David
(A)
D Kadoche
(D)
F Dufour
(F)
G Goin
(G)
Y Goudard
(Y)
G Pauleau
(G)
P Sockeel
(P)
B Villeon
(B)
K Pautrat
(K)
C Eveno
(C)
S Abdalla
(S)
A C Couchard
(AC)
G Balbo
(G)
J Y Mabrut
(JY)
J Bellinger
(J)
M Bertrand
(M)
A Aumont
(A)
E Duchalais
(E)
A S Messière
(AS)
A Tranchart
(A)
J B Cazauran
(JB)
V Pichot-Delahaye
(V)
V Dubuisson
(V)
L Maggiori
(L)
Y Panis
(Y)
B Djawad-Boumediene
(B)
D Fuks
(D)
X Kahn
(X)
E Huart
(E)
J M Catheline
(JM)
G Lailler
(G)
O Baraket
(O)
P Baque
(P)
J M Diaz de Cerio
(JM)
P Mariol
(P)
B Maes
(B)
P Fernoux
(P)
P Guillem
(P)
E Chatelain
(E)
C de Saint Roman
(C)
K Fixot
(K)
T Voron
(T)
Y Parc
(Y)
Informations de copyright
Colorectal Disease © 2020 The Association of Coloproctology of Great Britain and Ireland.
Références
McArdle CS, McMillan DC, Hole DJ. The impact of blood loss, obstruction and perforation on survival in patients undergoing curative resection for colon cancer. Br J Surg 2006; 93: 483-8.
Torre LA, Bray F, Siegel RL et al. Global cancer statistics, 2012. CA Cancer J Clin 2015; 65: 87-108.
Mege D, Manceau G, Bridoux V et al. Surgical management of obstructive left colon cancer at a national level: results of a multicentre study of the French Surgical Association in 1500 patients. J Visc Surg 2019; 156: 197-208.
Ansaloni L, Andersson RE, Bazzoli F et al. Guidelenines in the management of obstructing cancer of the left colon: consensus conference of the world society of emergency surgery (WSES) and peritoneum and surgery (PnS) society. World J Emerg Surg 2010; 5: 29.
Frago R, Ramirez E, Millan M et al. Current management of acute malignant large bowel obstruction: a systematic review. Am J Surg 2014; 207: 127-38.
Single-stage treatment for malignant left-sided colonic obstruction: a prospective randomized clinical trial comparing subtotal colectomy with segmental resection following intraoperative irrigation. The SCOTIA Study Group. Subtotal Colectomy versus On-table Irrigation and Anastomosis. Br J Surg 1995; 82: 1622-7.
Hennekinne-Mucci S, Tuech JJ, Brehant O et al. Emergency subtotal/total colectomy in the management of obstructed left colon carcinoma. Int J Colorectal Dis 2006; 21: 538-41.
Arnaud JP, Bergamaschi R. Emergency subtotal/total colectomy with anastomosis for acutely obstructed carcinoma of the left colon. Dis Colon Rectum 1994; 37: 685-8.
Villar JM, Martinez AP, Villegas MT et al. Surgical options for malignant left-sided colonic obstruction. Surg Today 2005; 35: 275-81.
Kube R, Granowski D, Stubs P et al. Surgical practices for malignant left colonic obstruction in Germany. Eur J Surg Oncol 2010; 36: 65-71.
Manceau G, Mege D, Bridoux V et al. Emergency surgery for obstructive colon cancer in elderly patients: results of a multicentric cohort of the French National Surgical Association. Dis Colon Rectum 2019; 62: 941-51.
Manceau G, Mege D, Bridoux V et al. Thirty-day mortality after emergency surgery for obstructing colon cancer: survey and dedicated score from the French Surgical Association. Colorectal Dis 2019; 21: 782-90.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240: 205-13.
von Elm E, Altman DG, Egger M et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370: 1453-7.
Aslar AK, Ozdemir S, Mahmoudi H, Kuzu MA. Analysis of 230 cases of emergent surgery for obstructing colon cancer-lessons learned. J Gastrointest Surg 2011; 15: 110-9.
Faucheron JL, Paquette B, Trilling B et al. Emergency surgery for obstructing colonic cancer: a comparison between right-sided and left-sided lesions. Eur J Trauma Emerg Surg 2018; 44: 71-7.
Tiret E. Emergency management for colonic cancer. Gastroenterol Clin Biol 1998; 22: S102-7.
Stephenson BM, Shandall AA, Farouk R, Griffith G. Malignant left-sided large bowel obstruction managed by subtotal/total colectomy. Br J Surg 1990; 77: 1098-102.
Papa MZ, Karni T, Koller M et al. Avoiding diarrhea after subtotal colectomy with primary anastomosis in the treatment of colon cancer. J Am Coll Surg 1997; 184: 269-72.
Biondo S, Pares D, Frago R et al. Large bowel obstruction: predictive factors for postoperative mortality. Dis Colon Rectum 2004; 47: 1889-97.
Reemst PH, Kuijpers HC, Wobbes T. Management of left-sided colonic obstruction by subtotal colectomy and ileocolic anastomosis. Eur J Surg 1998; 164: 537-40; discussion 41-2.
You YN, Chua HK, Nelson H et al. Segmental vs. extended colectomy: measurable differences in morbidity, function, and quality of life. Dis Colon Rectum 2008; 51: 1036-43.
Benson AB 3rd, Schrag D, Somerfield MR et al. American Society of Clinical Oncology recommendations on adjuvant chemotherapy for stage II colon cancer. J Clin Oncol 2004; 22: 3408-19.
Costas-Chavarri A, Nandakumar G, Temin S et al. Treatment of Patients With Early-Stage Colorectal Cancer: ASCO Resource-Stratified Guideline. J Glob Oncol 2019; 5: 1-19.
Kumar A, Kennecke HF, Renouf DJ et al. Adjuvant chemotherapy use and outcomes of patients with high-risk versus low-risk stage II colon cancer. Cancer 2015; 121: 527-34.
van der Bij GJ, Oosterling SJ, Beelen RH et al. The perioperative period is an underutilized window of therapeutic opportunity in patients with colorectal cancer. Ann Surg 2009; 249: 727-34.
Foxtrot CG. Feasibility of preoperative chemotherapy for locally advanced, operable colon cancer: the pilot phase of a randomised controlled trial. Lancet Oncol 2012; 13: 1152-60.
Arredondo J, Gonzalez I, Baixauli J et al. Tumor response assessment in locally advanced colon cancer after neoadjuvant chemotherapy. J Gastrointest Oncol 2014; 5: 104-11.
Jakobsen A, Andersen F, Fischer A et al. Neoadjuvant chemotherapy in locally advanced colon cancer. A phase II trial. Acta Oncol 2015; 54: 1747-53.
Karoui M, Rullier A, Piessen G et al. Perioperative FOLFOX 4 versus FOLFOX 4 plus cetuximab versus immediate surgery for high-risk stage II and III colon cancers: a phase II multicenter randomized controlled trial (PRODIGE 22). Ann Surg 2020; 271: 637-45.