A New Prognostic Marker in Patients Undergoing Hartmann’s Procedure for Acute Tumoral Obstruction of the Left Colon

Abstract

BACKGROUND: In acute obstructive left-sided colorectal cancers (AOLCRC), damage to the colon wall may occur as a result of distension of the colon segments proximal to the tumor. In this study, we aimed to evaluate the relationship between the ratio of dilated colon diameter (CD) to lumbar vertebral corpus diameter on preoperative abdominal computed tomography (CT) scan in patients undergoing Hartmann’s Procedure (HP) and post-operative complications. METHODS: The tumor group consisted of 49 patients who underwent HP for AOLCRC under emergency conditions. The control group consisted of 49 age-and gender-matched individuals (compatible with tumor group) that had an abdominal CT due to pathologies outside the gastrointestinal tract and without a history of abdominal surgery. In both group, the ratios of the CD to the diameter of the first lumbar vertebra corpus (L1-VD) measured on axial CT images of each patient. These ratios were compared between groups. In the tumor group, the relationship between post-operative complications (Clavien-Dindo classification-major (grade ≥III), minor (grade <III)) and demographic characteristics, pre-operative biochemical values, comorbid diseases, tumor pathological stage, operation time, and colon segments’ CD/L1-VD ratios was evaluated. RESULTS: The CD/L1-VD ratio in the tumor group was significantly higher than that of the control group (p<0.001). An increase in the pre-operative transverse and descending colon CD/L1-VD ratios in the tumor group were found to be a prognostic parameter for the development of major post-operative complications (p<0.001 and p=0.015, respectively), with the cut-off values as 1.52 and 1.21 (p=0.013 and p=0.042), respectively. The increase in the pre-operative transverse colon CD/L1-VD ratio was also associated with the increase in the blood urea level (p=0.044). A positive correlation was observed between the pre-operative blood urea levels and post-operative complications (p=0.015). CONCLUSION: Pre-operative transverse and descending colon CD/L1-VD ratios in AOLCRC are promising prognostic parameters for major postoperative complications.