Surgical management of obstructive right-sided colon cancer at a national level results of a multicenter study of the French Surgical Association in 776 patients

Mège, Diane; Manceau, Gilles; Bridoux, Valérie; Lakkis, Zaher; Venara, Aurélien; Voron, Thibault; Brunetti, Francesco; Sielezneff, I.; Karoui, Mehdi; Berger, Anne; Ouaïssi, Mehdi; Codjia, Tatiana; Dazza, Marie; Gagnat, Guillaume; Hamel, Servane; Mallet, L; Martre, P; Philouze, Guillaume; Roussel, Edouard; Tortajada, Pauline; Dumaine, A; Heyd, Bruno; Lakkis, Zaher; Paquette, Brice; Angelis, Nicola De; Esposito, Francesco; Lizzi, Vincenzo; Michot, Nicolas; Denost, Quentin; Trésallet, Christophe; Tetard, Oriana; Sabbagh, Charles; Rivier, Pauline; Fayssal, Elie; Collard, M.; Moszkowicz, David; Peschaud, Frédérique; Etienne, Jean Charles; Loge, Ludovic; Beyer-Berjot, Laura; Bège, Thierry; Corté, Hélène; Bonnet, Julien; 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; Tranchart, Anne-Sophie Messière 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; Maes, Philippe Mariol Bernard; Fernoux, Philippe; Guillem, Philippe; Chatelain, Eric; Roman, C; Fixot, K.

doi:10.1016/j.ejso.2018.06.027

Cited by 33 publications

(29 citation statements)

References 25 publications

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“…As for right‐sided OCRC, emergency colectomy with primary anastomosis is the standard of care in Western countries . However, emergency colectomy for right‐sided OCRC was associated with increased morbidity and mortality, and it is a challenge for surgeons and anesthesiologists to manage the patient in a suboptimal condition in the emergency setting. In a retrospective study of 776 patients in France, postoperative morbidity and mortality rates for emergency surgery for right‐sided OCRC were 51% and 10%, respectively, and age >70 years, American Society of Anesthesiology (ASA) score ≥3, and hemodynamic instability at admission were independent predictors for postoperative mortality .…”

Section: Discussionmentioning

confidence: 99%

“…With regard to right‐sided OCRC, resection with primary anastomosis is considered the treatment of choice . However, in some series, reported anastomotic leak rate was 2.5%~16.4%, and mortality was higher compared to left‐sided OCRC, suggesting choosing safer therapeutic options might be feasible in some cases. Management options for left‐sided OCRC, which accounts for 70% of OCRC, are more diverse.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the long‐term outcomes of the self‐expandable metallic stent and transanal decompression tube for obstructive colorectal cancer

Sato

Oikawa

Kakita

et al. 2019

Annals of Gastroent Surgery

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Aim Endoscopic decompression using the self‐expandable metallic colonic stent (SEMS) or transanal decompression tube (TDT) can convert emergency surgery into elective one‐stage surgery for obstructive colorectal cancer (OCRC). The aim of the present study was to clarify the effect of SEMS and TDT on long‐term oncological outcomes. Methods We retrospectively analyzed 76 consecutive pathological stage II and III OCRC patients who were inserted with SEMS or TDT as a bridge to curative surgery between 2009 and 2018. Results There were 53 SEMS cases and 23 TDT cases. The tumor was located in the left colon in 58 cases and in the right colon in 18 cases. The interval between the decompression and the surgery was 16.5 days in the SEMS group and 13.0 days in the TDT group (P = 0.09). Technical and clinical success rates were 100% and 100% for SEMS, and 95% and 91% for TDT, respectively. Stoma was created in four patients in the SEMS group, and in five in the TDT group (P = 0.08). Three‐year overall survival rates of the SEMS and TDT groups were 82% and 86% (P = 0.94), and disease‐free survival rates were 68% and 62% (P = 0.79), respectively. The recurrence pattern was not significantly different. Conclusion This study found no statistically significant differences between the effects of SEMS and TDT for OCRC as a bridge to surgery on long‐term outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of the long‐term outcomes of the self‐expandable metallic stent and transanal decompression tube for obstructive colorectal cancer

Sato

Oikawa

Kakita

et al. 2019

Annals of Gastroent Surgery

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“…As previously described, we collected data retrospectively from all consecutive patients who were managed for OCC between 1 January 2000 and 31 December 2015 in French surgical centres by members of the AFC . The data were given by the participating surgeons from each centre on a voluntary basis, after institutional approval.…”

Section: Methodsmentioning

confidence: 99%

Thirty‐day mortality after emergency surgery for obstructing colon cancer: survey and dedicated score from the French Surgical Association

Manceau

Mège²,

Bridoux

et al. 2019

Colorectal Disease

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AimThe aim was to define risk factors for postoperative mortality in patients undergoing emergency surgery for obstructing colon cancer (OCC) and to propose a dedicated score.Method From 2000 to 2015, 2325 patients were treated for OCC in French surgical centres by members of the French National Surgical Association. A multivariate analysis was performed for variables with P value ≤ 0.20 in the univariate analysis for 30-day mortality. Predictive performance was assessed by the area under the receiver operating characteristic curve.Results A total of 1983 patients were included. Thirtyday postoperative mortality was 7%. Multivariate analysis found five significant independent risk factors: age ≥ 75 (P = 0.013), American Society of Anesthesiologists (ASA) score ≥ III (P = 0.027), pulmonary comorbidity (P = 0.0002), right-sided cancer (P = 0.047) and haemodynamic failure (P < 0.0001). The odds ratio for risk of postoperative death was 3.42 with one factor, 5.80 with two factors, 15.73 with three factors, 29.23 with four factors and 77.25 with five factors. The discriminating capacity in predicting 30-day postoperative mortality was 0.80.Conclusion Thirty-day postoperative mortality after emergency surgery for OCC is correlated with age, ASA score, pulmonary comorbidity, site of tumour and haemodynamic failure, with a specific score ranging from 0 to 5.

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“…Previous studies reported high postoperative mortality (8·8–14·5 per cent) and morbidity (32–54·3 per cent) rates in patients with malignant right colonic obstructions managed by urgent surgery. In the present study, the in‐hospital mortality rate was only 1·6 per cent in the urgent colectomy group and 0·9 per cent in the SBTS group.…”

Section: Discussionmentioning

confidence: 97%

Stent as a bridge to surgery or immediate colectomy for malignant right colonic obstruction: propensity-scored, national database study

Sakamoto

Fujiogi

Lefor

et al. 2020

British Journal of Surgery

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Background The aim of this study was to compare perioperative outcomes of urgent colectomy and placement of a self‐expanding metallic stent followed by colectomy for patients with malignant right colonic obstruction. Right‐sided malignant obstruction is less common than left‐sided. Stenting for malignant left colonic obstruction has been reported to reduce postoperative complications. However, the impact of stenting for malignant right colonic obstruction remains undefined. Methods The study included patients with right‐sided malignant obstruction or stenosis undergoing colectomy between April 2012 and March 2017 identified from a nationwide database. Propensity score matching analysis was used to compare mortality and morbidity rates, proportion receiving a stoma and postoperative stay between urgent colectomy and stent groups. Results From 9572 patients, 1500 pairs were generated by propensity score matching. There was no significant difference in in‐hospital mortality between the urgent colostomy and stent groups (1·6 versus 0·9 per cent respectively; P = 0·069). Complications were more common after urgent colectomy than stenting (22·1 versus 19·1 per cent; P = 0·042). Surgical‐site infection was more likely with urgent colectomy (7·1 versus 4·4 per cent; P = 0·001). There was no significant difference between the two groups in anastomotic leakage (3·8 versus 2·6 per cent; P = 0·062). The proportion of patients needing a stoma was higher with urgent colectomy than primary treatment with stents (5·1 versus 1·7 per cent; P < 0·001). Postoperative stay was longer after urgent colectomy (15 versus 13 days; P < 0·001). Conclusion Stenting followed by colectomy in patients with malignant right colonic obstruction may provide more favourable perioperative outcomes than urgent colectomy.

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Surgical management of obstructive right-sided colon cancer at a national level results of a multicenter study of the French Surgical Association in 776 patients

Cited by 33 publications

References 25 publications

Comparison of the long‐term outcomes of the self‐expandable metallic stent and transanal decompression tube for obstructive colorectal cancer

Comparison of the long‐term outcomes of the self‐expandable metallic stent and transanal decompression tube for obstructive colorectal cancer

Thirty‐day mortality after emergency surgery for obstructing colon cancer: survey and dedicated score from the French Surgical Association

Stent as a bridge to surgery or immediate colectomy for malignant right colonic obstruction: propensity-scored, national database study

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