Reviewing the Management of Obstructive Left Colon Cancer: Assessing the Feasibility of the One-stage Resection and Anastomosis After Intraoperative Colonic Irrigation

Awotar, Gavish K.; Guan, Guoxin; Sun, Wei; Yu, H; Zhu, Minghui; Cui, Xinye; Liu, Jie; Chen, Jiaxi; Yang, Baoshun; Lin, J. K.; Deng, Zeyong; Luo, Jian; Wang, Chen; Nur, Osman Abdifatah; Dhiman, Pankaj; Liu, Pixu; Luo, Fang

doi:10.1016/j.clcc.2016.12.001

Cited by 26 publications

(10 citation statements)

References 60 publications

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“…To date, there is no consensus on whether the benefits outweigh the risks on morbidity and mortality. [8][9][10] Proximal diversion or end colostomies with mucous fistulas are options to consider if concerned for contamination, patient stability, advanced malignancy, or the condition of the bowel itself. 3 In the urgent setting, these may be the safest options.…”

Section: Large Bowel Obstruction Johnson Hawkins 235mentioning

confidence: 99%

Large Bowel Obstruction

Johnson

Hawkins

2021

Clin Colon Rectal Surg

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Nearly one-quarter of bowel obstructions occur in the large bowel. As with all bowel obstructions, large bowel obstructions have three defining characteristics: partial or complete, intrinsic or extrinsic, benign or malignant. The work-up for a large bowel obstruction should focus on the etiology of the obstruction as well as severity. Management strategy is contingent on the previous characteristics and can include endoscopy, diversion, or resection. This chapter will discuss common and rare etiologies of large bowel obstructions as well as management strategies for clinical guidance.

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Section: Large Bowel Obstruction Johnson Hawkins 235mentioning

confidence: 99%

Large Bowel Obstruction

Johnson

Hawkins

2021

Clin Colon Rectal Surg

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“…About 20% of patients with CRC are diagnosed with acute colonic obstruction, which is located in the left colon in two thirds of them [1][2]. Urgent surgery for obstructive colon cancer is associated with increased risk of postoperative morbidity, mortality and permanent stoma rates as it usually occurs in elderly patients with poor medical condition or in those with high comorbidities [3][4][5]. Furthermore, 40 to 60% of obstructive colon cancers are locally advanced or metastatic at diagnosis and, at equal tumour stage, obstruction itself impaires oncological outcomes in colon cancer patients [2,[6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Surgical management of obstructive left colon cancer at a national level: Results of a multicentre study of the French Surgical Association in 1500 patients

Mège

Manceau

Bridoux³

et al. 2019

Journal of Visceral Surgery

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Surgical management of obstructive left colon cancer (OLCC) is controversial. The objective is to report on postoperative and oncological outcomes of the different surgical options in patients operated on for OLCC. Methods:From 2000-2015, 1500 patients were treated for OLCC in centers members of the French Surgical Association. Colonic stent (n=271), supportive care (n=5), palliative derivation (n=4) were excluded. Among 1220 remaining patients, 456 had primary diverting colostomy (PDC), 329 a segmental colectomy (SC), 246 a Hartmann's procedure (HP) and 189 a subtotal colectomy (STC) as first-stage surgery. Perioperative data and oncological outcomes were compared retrospectively.Results: There was no difference between the 4 groups regarding gender, age, BMI and comorbidities. Postoperative mortality and morbidity were 4-27% (PDC), 6-47% (SC), 9-55% (HP), 13-60% (STC), respectively (p=0.005). Among the 431 living patients after PDC, 321 (70%) patients had their primary tumour removed. Cumulative mortality and morbidity favoured PDC (7-39%) and SC (6-40%) compared to HP (1-47%) and STC (13-50%) (p=0.04). At the end of follow-up definitive stoma rates were 39% (HP), 24% (PDC), 10% (SC), and 8% (STC) (p<0.0001). Five-year overall and disease-free survival was: SC (67-55%), PDC (54-48%), HP (54-37%) and STC (48-49%). After multivariate analysis, SC and PDC were associated with better prognosis compared to HP and STC. Conclusion:In OLCC, SC and PDC are the two preferred options in patients with good medical conditions. For patients with severe comorbidities PDC should be recommended, reserving HP and STC for patients with colonic ischaemia or perforation complicating malignant obstruction.

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“…This was nearly similar to the results of Awotar et al, reporting 2.90% death rate and 5.56% of patients having anastomotic leak. 13 Anastomotic leakage occurred more in females. This was against the results of Rudinskaite et al, who studied 269 patients that underwent primary resection and anastomosis of colorectal cancer finding that anastomotic leakage in males were more than females (11.27% versus 3.15%).…”

Section: Discussionmentioning

confidence: 95%

Evaluation of one-stage management of left side cancer colon

2018

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Background: Colorectal cancer in Egypt remains a heavy burden as about 40% of cases occur in individuals under 40years of age. The one-stage resection and anastomosis surgery on the left colon due to carcinomas was lately proposed to be safely done. Aim of the work was to evaluate the immediate results of the one-stage resection and anastomosis surgery procedure for left colonic cancer patients and analyzing the relationship between occurrence of complications and clinico-pathological circumstances.Methods: This is a prospective clinical study included 20 patients with mean age 59.4years (70% males and 30% females) having left side cancer colon. All patients underwent history taking, clinical examination and one-stage resection and anastomosis surgery.Results: High percentage of leakage was noticed in females >50years, in diabetics, adenocarcinoma and ischemic heart disease. The leakage rate increased in those who stayed more in the hospital and decreased with the intraoperative preparation. High death rate was noticed in females >50years and in diabetic patients with ischemic heart disease, adenocarcinoma, and obstructed colon. The pre and intraoperative preparation decreased the risk of death. High percentage of wound infection was noticed in males <50years and in diabetic patients with adenocarcinoma and obstructed colon. The risk of wound infection was increased in patients who received intraoperative preparation and who stayed a week or less in the hospital.Conclusions: The incidence of postoperative complications was sound within values generally reported in other studies. Nonetheless, more effort is required to determine risk factors for such postoperative complications to improve the long-term as well as short-term survival in colorectal cancer patients.

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Reviewing the Management of Obstructive Left Colon Cancer: Assessing the Feasibility of the One-stage Resection and Anastomosis After Intraoperative Colonic Irrigation

Cited by 26 publications

References 60 publications

Large Bowel Obstruction

Large Bowel Obstruction

Surgical management of obstructive left colon cancer at a national level: Results of a multicentre study of the French Surgical Association in 1500 patients

Evaluation of one-stage management of left side cancer colon

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