D Mege1, G Manceau2, V Bridoux3, T Voron4, C Sabbagh5, Z Lakkis6, A Venara7, M Ouaissi8, Q Denost9, V Kepenekian10, I Sielezneff11, M Karoui12. 1. Department of Digestive Surgery, Timone University Hospital, 264, rue Saint-Pierre, 13005 Marseille 05 Provence-Alpes-Côte d'Azur, France. Electronic address: dianemege@hotmail.fr. 2. Department of Digestive Surgery, Médecine Sorbonne University, Pitié Salpêtrière University Hospital, Assistance publique des hôpitaux de Paris (AP-HP), 43-84, boulevard de l'Hôpital, 75013 Paris, France. Electronic address: gilles.manceau@aphp.fr. 3. Department of Digestive Surgery, Charles-Nicolle University Hospital, 37, boulevard Gambetta, 76000 Rouen, Haute Normandie Rouen, France. Electronic address: valerie.bridoux@chu-rouen.fr. 4. Department of Digestive Surgery, Médecine Sorbonne University, Saint-Antoine University Hospital, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France. Electronic address: thibault.voron@gmail.com. 5. Department of Digestive Surgery, Amiens University Hospital, 2, place Victor-Pauchet, 80054 Amiens cedex, France. Electronic address: sabbagh.charles@chu-amiens.fr. 6. Department of Digestive Surgery, Besançon University Hospital, 3, boulevard Alexandre-Fleming, 25000 Besançon, France. Electronic address: zaher.lakkis@gmail.com. 7. Department of Digestive Surgery, Angers University Hospital, 4, rue Larrey, 49100 Angers, France. Electronic address: auvenara@chu-angers.fr. 8. Department of Digestive Surgery, Tours University Hospital, 2, allée Gaston-Pages, 37081 Tours, France. Electronic address: ouaissi_mehdi@hotmail.com. 9. Department of Digestive Surgery, Haut-Lévèque University Hospital, avenue Magellan, 33600 Pessac, France. Electronic address: quentin.denost@chu-bordeaux.fr. 10. Department of Digestive Surgery, Lyon Sud University Hospital, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénit, France. Electronic address: vahankep@yahoo.fr. 11. Department of Digestive Surgery, Timone University Hospital, 264, rue Saint-Pierre, 13005 Marseille 05 Provence-Alpes-Côte d'Azur, France. Electronic address: igor.sielezneff@ap-hm.fr. 12. Department of Digestive Surgery, Médecine Sorbonne University, Pitié Salpêtrière University Hospital, Assistance publique des hôpitaux de Paris (AP-HP), 43-84, boulevard de l'Hôpital, 75013 Paris, France. Electronic address: mehdi.karoui@aphp.fr.
Abstract
PURPOSE: 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.
PURPOSE: 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.