Emergency surgery for obstructive splenic flexure colon cancer: results of a multicentric study of the French Surgical Association (AFC)

Labiad, Camélia; Manceau, Gilles; Mège, Diane; Cazelles, Antoine; Voron, Thibault; Bridoux, Valérie; Lakkis, Zaher; Abdalla, Solafah; Karoui, Mehdi; Venara, Aurélien; Ouaïssi, Mehdi; Sabbagh, Charles; Codjia, Tatiana; Dazza, Marie; Gagnat, Guillaume; Hamel, Servane; Mallet, L; Martre, P; Philouze, Guillaume; Roussel, Edouard; Tortajada, Pauline; Dumaine, A; Heyd, Bruno; Paquette, Brice; Angelis, Nicolas de; Brunetti, F.; Esposito, Francesco; Lizzi, Vincenzo; Michot, Nicolas; Denost, Quentin; Trésallet, Christophe; Tetard, Oriana; Rivier, Pauline; Fayssal, Elie; Collard, M.; Moszkowicz, David; Peschaud, Frédérique; Etienne, Jean Charles; Loge, Ludovic; Beyer, Laura; Bège, Thierry; Corté, Hélène; D’Annunzio, Elsa; Humeau, Marine; Issard, Julien; Muñoz, Nicolás; Abba, J.; Jafar, Yaqoub; Lacaze, L.; Sage, Pierre Yves; Susoko, Lilija; Trilling, Bertrand; Arvieux, C.; Mauvais, F.; Severino, Beatrice; Pitel, Sophie; Chaumont, Arthus Vauchaussade de; Badic, Bogdan; Blanc, B; Bert, M.; Rat, P.; Ortega-Deballon, P.; Chau, Amélie; Dejeante, Clémentine; Mariette, C.; Piessen, Guillaume; Grégoire, Émilie; Alfarai, Abdallah; Lefèvre, Jérémie H.; Cabau, Magali; David, Anaëlle; Kadoche, Déborah; Dufour, Fanny; Goin, G.; Goudard, Yvain; Pauleau, Ghislain; Sockeel, Philippe; Villéon, Bruno de La; Pautrat, Karine; Eveno, Clarisse; Brouquet, Antoine; Couchard, Anne Cécile; Balbo, G; Mabrut, Jean Yves; Bellinger, Justine; Bertrand, Martin; Aumont, Aurélie; Duchalais, Emilie; Messière, Anne-Sophie; Tranchart, Adrien; Cazauran, Jean-Baptiste; Pichot‐Delahaye, Virginie; Dubuisson, Vincent; Maggiori, Léon; Boumediene, Bilem Djawad; Fuks, David; Kahn, X; Huart, Eve; Catheline, Jean Marc; Lailler, Grégory; Baraket, Oussama; Baqué, Patrick; Cerio, Jean Marie Diaz de; Mariol, P.; Maes, Bernard; Fernoux, Philippe; Guillem, Philippe; Chatelain, Eric; Roman, C; Fixot, K.

doi:10.1007/s13304-021-01206-0

Cited by 2 publications

(8 citation statements)

References 34 publications

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“…The results of this study showed that decompressing stoma (39%) and SFR (39%) were the most frequently performed procedures, while the left hemicolectomy procedure was performed least frequently (5%). However, no information was provided about the technique of the procedures (laparoscopic or open) [5]. Another multicentre study reported by the SFC Study Group evaluated a total of 90 emergency SFC patients, the majority of whom had OSFC (83.3%).…”

Section: Discussionmentioning

confidence: 99%

“…Three approaches have typically been adopted for surgical treatment: extended right/left hemicolectomy and SFR [1, 3]. Although SFR was previously approached with suspicion due to the uncertainty of oncological outcomes, recent studies have shown that SFR is not inferior to extended colectomy in terms of oncological outcomes [1, 3, 5, 6, 9]. On the other hand, there is uncertainty about the optimal surgical technique to be used in emergency situations.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, patients with SFC usually present with obstructive symptoms. In this case, open surgery is mostly preferred and the rate of SFR with primary anastomosis is quite low [5,6].…”

Section: Introductionmentioning

confidence: 99%

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Techniques and feasibility of the cranial‐to‐caudal approach for laparoscopic left colectomy in obstructive splenic flexure cancers: A consecutive case series (with video)

Göksoy

2022

Colorectal Disease

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Aim Laparoscopic surgery of splenic flexure cancers (SFCs) is one of the most challenging operations among other colorectal surgical procedures. The most commonly performed and recommended laparoscopic surgical technique is the medial‐to‐lateral approach. On the other hand, in obstructive splenic flexure cancers (OSFCs), the medial‐to‐lateral approach may not be possible due to the narrowed surgical field by dilated bowel and difficulty in positioning the bowel. This study aims to present the surgical technique and feasibility of laparoscopic left colectomy with cranial‐to‐caudal dissection as a new alternative method in OSFCs. Method All consecutive patients who underwent laparoscopic left colectomy with cranial‐to‐caudal dissection for OSFC between December 2018 and February 2022 were analysed. All procedures were performed by a single surgeon experienced in laparoscopic colorectal surgery and video recorded. Result Five consecutive cases of OSFC who underwent laparoscopic surgery with a cranial‐to‐caudal approach were evaluated. The median operating time was 180 (165–195) min, and the length of hospital stay was nine (7–12) days. The surgical margins were tumour‐free, and the median number of harvested lymph nodes was 20 (17–36). Four patients had pTNM stage 3B disease, and one patient had stage 2A disease. There were no major complications and mortality. Conclusion In this study, a new alternative surgical approach was used for OSFCs, one of the most challenging procedures in laparoscopic surgery. This technique can also be safely used not only in OSFCs but also in other left colon tumours (adhesions, obesity, etc.) that require splenic flexure mobilization and pose difficulty in a medial‐to‐lateral approach.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Techniques and feasibility of the cranial‐to‐caudal approach for laparoscopic left colectomy in obstructive splenic flexure cancers: A consecutive case series (with video)

Göksoy

2022

Colorectal Disease

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“…A recent large French multicenter study including 58 centers and 2325 patients with obstructed colorectal carcinoma, among whom 11% had splenic flexure obstruction and stenting in only 11.4%, found the following surgical interventions: (1) Decompressing stoma (39%); (2) segmental colectomy (39%); (3) subtotal colectomy (17%); and (4) left colectomy (5%). The rate of intraoperative complications was 3% and that of anastomotic leakage was 4%, without differences among the surgical procedures in terms of postoperative complications and oncological outcomes[ 46 ].…”

Section: Surgerymentioning

confidence: 99%

“…Plain abdominal radiogram shows marked colon dilation with possible small bowel dilation and air-fluid levels[ 46 ].…”

Section: Introductionmentioning

confidence: 99%

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

Pavlidis,

Galanis,

Pavlidis

2024

World J Gastrointest Oncol

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Colorectal carcinoma is common, particularly on the left side. In 20% of patients, obstruction and ileus may be the first clinical manifestations of a carcinoma that has advanced (stage II, III or even IV). Diagnosis is based on clinical presentation, plain abdominal radiogram, computed tomography (CT), CT colonography and positron emission tomography/CT. The best management strategy in terms of short-term operative or interventional and long-term oncological outcomes remains unknown. For the most common left-sided obstruction, the first choice should be either emergency surgery or endoscopic decompression by self-expendable metal stents or tubes. The operative plan should be either one-stage or two-stage resection. One-stage resection with on-table bowel decompression and irrigation can be accompanied or not accompanied by proximal defunctioning stoma (colostomy or ileostomy). Primary anastomosis is more convenient but has increased risks of anastomotic leakage and morbidity. Two-stage resection (Hartmann’s procedure) is safer and the most widely used despite temporally affecting quality of life. Damage control surgery in high-risk frail patients is less frequently performed since it can be successfully substituted with endoscopic stenting or tubing. For the less common right-sided obstruction, one-stage surgical resection is more beneficial than endoscopic decompression. The role of minimally invasive surgery (laparoscopic or robotic) is a subject of debate. Emergency laparoscopic-assisted management is advantageous to some extent but requires much expertise due to inherent difficulties in dissecting the distended colon and the risk of rupture and subsequent septic complications. The decompressing stent as a bridge to elective surgery more substantially decreases the risks of morbidity and mortality than emergency surgery for decompression and has equivalent medium-term overall survival and disease-free survival rates. Its combination with neoadjuvant chemotherapy or radiation may have a positive effect on long-term oncological outcomes. Management plans are crucial and must be individualized to better fit each case.

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Emergency surgery for obstructive splenic flexure colon cancer: results of a multicentric study of the French Surgical Association (AFC)

Cited by 2 publications

References 34 publications

Techniques and feasibility of the cranial‐to‐caudal approach for laparoscopic left colectomy in obstructive splenic flexure cancers: A consecutive case series (with video)

Techniques and feasibility of the cranial‐to‐caudal approach for laparoscopic left colectomy in obstructive splenic flexure cancers: A consecutive case series (with video)

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

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