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.
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.
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.
The colon-sparing strategy may represent a valid and safe alternative to STC in OLCC patients with caecal ischemia or diastatic perforation.
Obstructing colonic cancer; caecal ischemia; diastatic caecal perforation; left colon cancer; surgery