Endolaparoscopic Approach vs Conventional Open Surgery in the Treatment of Obstructing Left-Sided Colon Cancer

Cheung, Hester Yui Shan

doi:10.1001/archsurg.2009.216

Cited by 218 publications

(163 citation statements)

References 27 publications

(32 reference statements)

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“…(3) Las dos principales indicaciones para el tratamiento de la obstrucción maligna de colon son la descompresión de la luz intestinal previo a cirugía programada (puente a la cirugía), y paliación en caso de tumores no candidatos a intervención curativa.…”

Section: Indicacionesunclassified

“…El carcinoma colorectal puede debutar como obstrucción en un 7-29%, siendo la causa más frecuente de intervención urgente en estos casos ya que dejada a su evolución, la distensión progresiva del intestino progresa desde dolor abdominal con náuseas y vómitos hacia la isquemia intestinal, perforación, sepsis y posterior fallecimiento del paciente. (3) La cirugía urgente debe realizarse respetando los principios oncológicos aunque no se disponga de un diagnostico de certeza prequirúrgico, y la intención debe ser curativa si no hay evidencia de enfermedad a distancia. (1) La Tomografía Computarizada (TC) es la prueba radiológica de elección para localizar la lesión y la morfología de la obstrucción.…”

Section: Introductionunclassified

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Abordaje Terapéutico de la Obstrucción Maligna de Colon. Actualización en las Indicaciones de Endoprótesis

Cárdenas¹

2018

Arch. coloproctol.

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A pesar de los esfuerzos para el diagnóstico precoz del cáncer de colon con los programas de screening, más del 33% de los paciente con carcinoma colorectal debutan con síntomas que van a requerir de una intervención quirúrgica urgente tanto por perforación, obstrucción o hemorragia. Las tasas de morbilidad, mortalidad y la necesidad e estoma son mayores en los casos con intervención urgente en comparación con la cirugía electiva. Todo esto influye no sólo en la cirugía urgente, sino en las condiciones de los pacientes intervenidos, frecuentemente en contexto de deshidratación, desnutrición, descompensación hidroelectrolitica y de comorbilidades asociadas, con tumores con un comportamiento biológico más agresivo y mayor frecuencia de metástasis hepáticas. Además, el estudio de extensión es incompleto en estas situaciones, pudiendo condicionar el abordaje oncológico posterior. Teniendo en cuenta que deben respetarse los principios de resección oncológica para el carcinoma colorectal (márgenes distal, proximal y radial así como una linfadenctomia de al menos 12 ganglios) incluso en cirugía urgente, la Guía Americana de la Sociedad de Cirujanos colorectales define los siguientes objetivos para el tratamiento urgente de esta patología: evitar el impacto negativo inmediato de la complicación, conseguir el mejor control del tumor y asegurar que el tiempo de recuperación permita el inicio del tratamiento adyuvante más adecuado.

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Section: Indicacionesunclassified

Section: Introductionunclassified

Abordaje Terapéutico de la Obstrucción Maligna de Colon. Actualización en las Indicaciones de Endoprótesis

Cárdenas¹

2018

Arch. coloproctol.

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“…15 This guideline is based on the evidence from eight systematic reviews with meta-analysis comparing preoperative stenting with emergency resection for left-sided colonic malignant obstruction, 11,[36][37][38][39][40][41][42] with assimilated data from up to seven RCTs. [43][44][45][46][47][48][49] Three of those RCTs were closed early due to adverse outcomes in the SEMS group (higher 30-day morbidity related to stent perforation), 43,44 or high anastomotic leak rate in the emergency surgery group. 48 The most recently published meta-analysis found that SEMS as a bridge to surgery (n = 195) compared to emergency surgery (n = 187) had a lower overall morbidity (33.1% vs 53.9%, P = 0.03), a higher successful primary anastomosis rate (67.2% vs 55.1%, P < 0.01), and a lower permanent stoma rate (9% vs 27.4%, P < 0.01); however, there was no statistical difference in post-operative mortality (10.7% vs 12.4%).…”

Section: Sems As a Bridge To Elective Surgerymentioning

confidence: 99%

Colonic cancer: The current role of stent insertion

Newton

Hill

2017

Int J Gastrointest Interv

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Acute colonic obstruction secondary to left-colonic malignancy remains a common emergency condition. Traditional management is emergency surgery and has high morbidity and mortality. Self expandable metallic stents (SEMS) promised to improve morbidity and mortality, stoma rates and hospital stay. SEMS use in the potentially curative setting, as a bridge to surgery, is associated with an improved stoma rate and morbidity, but has no mortality benefit. There are concerns about oncological safety with higher local recurrence rates, thus SEMS is not recommended in this setting unless the patient has increased surgical risk and would benefit from a period of recovery prior to surgery. SEMS has a definite role in the palliative setting, for both patients with incurable disease or those with a high surgical risk. SEMS is associated with improved morbidity, mortality, and stoma rates. The technique for SEMS insertion is now well established but it is still unclear whether covered or uncovered stents are better.

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“…An at least theoretical approach to circumvent the emergency operation and its complications is the bridging of the obstruction with a stent. It allows after decompression of the left colon and mechanical bowel preparation scheduled surgery of the patient with a high rate of primary anastomoses [11][12][13] . In this context, I read the recent systematic review and meta-analysis published by Tan et al [14] with great interest and I strongly recommend it to readers.…”

Section: Commentary On Hot Topicsmentioning

confidence: 99%

Primary colon resection or Hartmann's procedure in malignant left-sided large bowel obstruction? The use of stents as a bridge to surgery

Grundmann¹

2013

WJGS

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There is still significant debate regarding the best surgical treatment for malignant left-sided large bowel obstruction. Primary resection and anastomosis offers the advantages of a definite procedure without need for further surgery. Its main disadvantages are related to the increased technical challenge and to the potential higher risk of anastomotic leakage that occurs in the emergency setting. Primary resection with end colostomy (Hartmann's procedure) is considered the safer option. Tan et al compared in a systematic review and meta-analysis the use of self-expanding metallic stents (SEMS) as a bridge to surgery vs emergency surgery in the management of acute malignant left-sided large bowel obstruction. The authors concluded that the technical and clinical success rates for stenting were lower than expected. SEMS was associated with a high incidence of clinical and silent perforation. Stenting instead of loop colostomy can be recommended only if the appropriate expertise is available in the hospital. The goal of stenting, a decrease of the stoma rate, may be advocated only if the complication rates of stenting are lower than those of stoma creation in the emergency situation. Until now, this was not demonstrated in a prospective randomized trial. COMMENTARY ON HOT TOPICSThere is still significant debate regarding the best surgical treatment for malignant left-sided large bowel obstruction. In a multicenter German observation study, out of 15 911 patients with cancer of the left colon a total of 743 patients (4.7%) underwent emergency surgery, performed as a radical resection. In 57.9% (n = 430) a one-stage operation, in 11.7% (n = 87) a primary anastomosis with protective stoma, and in 30.4% (n = 226) Hartmann's procedure (HP) were performed [1] . The morbidity and hospital mortality rates (overall hospital mortality, 7.7%, n = 57) did not differ significantly between the groups. With comparable mortality, HP was recommended for high risk patients in the emergency situation. On the basis of a literature search, Trompetas [2] came to a similar conclusion: primary resection with end colostomy (HP) is considered the safest option in malignant left-sided colonic obstruction. The main advantages are that there is no risk of anastomotic dehiscence and the operation can be performed by less experienced and non-specialist surgeons. The main disadvantages of HP are the need for a second major operation to reverse the colostomy, and the fact that 40%-60% of patients do

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Endolaparoscopic Approach vs Conventional Open Surgery in the Treatment of Obstructing Left-Sided Colon Cancer

Cited by 218 publications

References 27 publications

Abordaje Terapéutico de la Obstrucción Maligna de Colon. Actualización en las Indicaciones de Endoprótesis

Abordaje Terapéutico de la Obstrucción Maligna de Colon. Actualización en las Indicaciones de Endoprótesis

Colonic cancer: The current role of stent insertion

Primary colon resection or Hartmann's procedure in malignant left-sided large bowel obstruction? The use of stents as a bridge to surgery

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