1. Colon sparing resection versus extended colectomy for left‐sided obstructing colon cancer with caecal ischaemia or perforation: a nationwide study from the French Surgical Association.
- Author
-
Manceau, G., Sabbagh, C., Mege, D., Lakkis, Z., Bege, T., Tuech, J. J., Benoist, S., Lefèvre, J. H., Karoui, M., Regimbeau, J. M., Bridoux, V., Venara, A., Beyer‐Berjot, L., Codjia, T., Dazza, M., Gagnat, G., Hamel, S., Mallet, L., Martre, P., and Philouze, G.
- Subjects
COLECTOMY ,COLOSTOMY ,COLON cancer ,COLON (Anatomy) ,ISCHEMIA ,PROGRESSION-free survival ,STATISTICAL significance - Abstract
Aim: It is not known whether patients with obstructive left colon cancer (OLCC) with caecal ischaemia or diastatic perforation (defined as a blowout of the caecal wall related to colonic overdistension) should undergo a (sub)total colectomy (STC) or an ileo‐caecal resection with double‐barrelled ileo‐colostomy. We aimed to compare the results of these two strategies. Method: From 2000 to 2015, 1220 patients with OLCC underwent surgery by clinicians who were members of the French Surgical Association. Of these cases, 201 (16%) were found to have caecal ischaemia or diastatic perforation intra‐operatively: 174 patients (87%) underwent a STC (extended colectomy group) and 27 (13%) an ileo‐caecal resection with double‐end stoma (colon‐sparing group). Outcomes were compared retrospectively. Results: In the extended colectomy group, 95 patients (55%) had primary anastomosis and 79 (45%) had a STC with an end ileostomy. In the colon‐sparing group, 10 patients (37%) had simultaneous resection of their primary tumour with segmental colectomy and an anastomosis which was protected by a double‐barrelled ileo‐colostomy. The demographic data for the two groups were comparable. Median operative time was longer in the STC group (P = 0.0044). There was a decrease in postoperative mortality (7% vs 12%, P = 0.75) and overall morbidity (56% vs 67%, P = 0.37) including surgical (30% vs 40%, P = 0.29) and severe complications (17% vs 27%, P = 0.29) in the colon‐sparing group, although these differences did not reach statistical significance. Cumulative morbidity included all surgical stages and the rate of permanent stoma was 66% and 37%, respectively, with no significant difference between the two groups. Overall survival and disease‐free survival were similar between the two groups. Conclusion: The colon‐sparing strategy may represent a valid and safe alternative to STC in OLCC patients with caecal ischaemia or diastatic perforation. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF