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

Abstract

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.

Prognostic factors of patients with left-sided obstructive colorectal cancer: post hoc analysis of a retrospective multicenter study by the Japan Colonic Stent Safe Procedure Research Group

“…Most studies on obstructive CRC report on the comparison with nonobstructive CRC and the efficacy of SEMS as BTS; there are few analyses on the prognostic factors of obstructive CRC. For BTS, there is no difference between decompression using a temporary stoma and SEMS [ 24 ]; many recent reports and meta-analyses show no difference in long-term outcomes between BTS using SEMS and emergency surgery [ 10 , 12 , 25 ]. Regarding BTS using TADT, small retrospective studies mostly from Japan showed no difference in outcomes from BTS using SEMS [ 26 ].…”

Risk Factors for Mortality in Cases of Obstructed Left Colonic Carcinoma

“…Likewise, Biondo et al reported that the presence of preoperative renal failure was a significant risk factor for mortality after obstructing colon cancer operations (p = 0.0005) (30). Contrarily, Mege et al also denied any significant impact of renal comorbidity on mortality after surgery for the same pathology (p = 0.33) (31).…”

Prognostic Factors of Patients with Left-sided Obstructive Colorectal Cancer: Post-hoc Analysis of a Retrospective Multi-center Study in the Japan Colonic Stent Safe Procedure Research Group

“…Most of the studies on obstructive CRC report on the comparison with non-obstructive CRC and the e cacy of SEMS as BTS; there are few analyses on the prognostic factors of obstructive CRC. For BTS, there is no difference between decompression using temporary stoma and SEMS [24]; many recent reports and meta-analyses show no difference in long-term outcomes between BTS using SEMS and emergency surgery [10,12,25]. Regarding BTS using TADT, retrospective studies, which are small in size and mostly from Japan, show no difference from BTS using SEMS [26].…”