Abstract
PURPOSE:
Whether obstructive left colon cancer (OLCC) patients with caecal ischemia or diastatic perforation (defined as a blowout of the caecal wall related to a colon overdistension) should undergo a (sub)total colectomy (STC) or an ileo-caecal resection with double-barreled ileo-colostomy is unknown. We aimed to compare the results of these two strategies.
METHODS:
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 ischemia or diastatic perforation intraoperatively: 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 two groups were comparable for demographic data. 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 ischemia or diastatic perforation.
KEYWORDS:
Obstructing colonic cancer; caecal ischemia; diastatic caecal perforation; left colon cancer; surgery
