Diane Mege1, Gilles Manceau2, Laura Beyer-Berjot3, Valérie Bridoux4, Zaher Lakkis5, Aurélien Venara6, Thibault Voron7, Francesco Brunetti8, Igor Sielezneff1, Mehdi Karoui9. 1. Department of Digestive Surgery, Assistance Publique Hôpitaux de Marseille, Timone University Hospital, Marseille, France. 2. Medecine Sorbonne University, Assistance Publique Hôpitaux de Paris, Department of Digestive and Hepato-Pancreato-Biliary Surgery, Pitié-Salpêtrière University Hospital, Paris VI University Institute of Cancerology, Paris, France. 3. Department of Digestive Surgery, Assistance Publique Hôpitaux de Marseille, North Hospital, Aix-Marseille Université, Marseille, France. 4. Department of Digestive Surgery, Rouen University Hospital, Rouen, France. 5. Department of Digestive Surgery, Besançon University Hospital, France. 6. Department of Digestive Surgery, Angers University Hospital, France. 7. Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Georges Pompidou European University Hospital, Paris, France. 8. Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Henri Mondor University Hospital, Creteil, France. 9. Medecine Sorbonne University, Assistance Publique Hôpitaux de Paris, Department of Digestive and Hepato-Pancreato-Biliary Surgery, Pitié-Salpêtrière University Hospital, Paris VI University Institute of Cancerology, Paris, France. Electronic address: mehdi.karoui@aphp.fr.
Abstract
AIM: To report the results of surgery for obstructive right colon cancer (ORCC) and to identify risk factors associated with worse outcomes that may help surgeons to choose the best surgical option. METHODS: This is a retrospective national cohort study, including all patients operated on for ORCC from 2000 to 2015. Those treated with colonic stent or symptomatic treatment were excluded. We described outcomes after surgery for ORCC and performed multivariate analyses for mortality, morbidity and survival. RESULTS: Among 776 patients analyzed, 716 (92%) had their primary tumor removed, with primary anastomosis in 582 (82%). The remaining 194 underwent anastomosis with loop ileostomy (n = 21), resection with double-end stoma (n = 113), defunctioning stoma without resection (n = 48) and ileocolic by-pass (n = 12). Postoperative mortality, morbidity and anastomotic leak rates were 10%, 51% and 14%, respectively. In multivariate analysis, age >70, ASA score ≥3 and hemodynamic instability were predictors of postoperative mortality whereas ASA score ≥3, hemodynamic instability and intra-operative complications were predictors of severe morbidity. No factors were correlated with anastomotic leak. After a median follow-up of 26 months, 8% of patients were alive with a permanent stoma. Five-year overall, disease-free and cancer-specific survival was 42%, 42% and 62%, respectively. In multivariate analysis, peritonitis, synchronous metastases and absence of adjuvant chemotherapy were predictors of decreased overall survival. CONCLUSIONS: Emergency surgery for ORCC is associated with high mortality and morbidity. Two third of patients with ORCC can be managed with resection and primary anastomosis. For high-risk patients, a staged surgical management may be discussed.
AIM: To report the results of surgery for obstructive right colon cancer (ORCC) and to identify risk factors associated with worse outcomes that may help surgeons to choose the best surgical option. METHODS: This is a retrospective national cohort study, including all patients operated on for ORCC from 2000 to 2015. Those treated with colonic stent or symptomatic treatment were excluded. We described outcomes after surgery for ORCC and performed multivariate analyses for mortality, morbidity and survival. RESULTS: Among 776 patients analyzed, 716 (92%) had their primary tumor removed, with primary anastomosis in 582 (82%). The remaining 194 underwent anastomosis with loop ileostomy (n = 21), resection with double-end stoma (n = 113), defunctioning stoma without resection (n = 48) and ileocolic by-pass (n = 12). Postoperative mortality, morbidity and anastomotic leak rates were 10%, 51% and 14%, respectively. In multivariate analysis, age >70, ASA score ≥3 and hemodynamic instability were predictors of postoperative mortality whereas ASA score ≥3, hemodynamic instability and intra-operative complications were predictors of severe morbidity. No factors were correlated with anastomotic leak. After a median follow-up of 26 months, 8% of patients were alive with a permanent stoma. Five-year overall, disease-free and cancer-specific survival was 42%, 42% and 62%, respectively. In multivariate analysis, peritonitis, synchronous metastases and absence of adjuvant chemotherapy were predictors of decreased overall survival. CONCLUSIONS: Emergency surgery for ORCC is associated with high mortality and morbidity. Two third of patients with ORCC can be managed with resection and primary anastomosis. For high-risk patients, a staged surgical management may be discussed.
Authors: Jeske R E Boeding; Winesh Ramphal; Arjen M Rijken; Rogier M P H Crolla; Cornelis Verhoef; Paul D Gobardhan; Jennifer M J Schreinemakers Journal: Ann Surg Oncol Date: 2020-10-16 Impact factor: 5.344