Guidelines in the management of obstructing cancer of the left colon: consensus conference of the world society of emergency surgery (WSES) and peritoneum and surgery (PnS) society

Ansaloni, Luca; Andersson, Roland; Bazzoli, Franco; Catena, Fausto; Cennamo, Vincenzo; Saverio, Salomone Di; Fuccio, Lorenzo; Jeekel, Hans; Leppäniemi, Ari; Moore, Ernest E.; Pinna, Antonio; Pisano, Michele; Repici, Alessandro; Sugarbaker, Paul H.; Tuech, J J

doi:10.1186/1749-7922-5-29

Cited by 171 publications

(126 citation statements)

References 59 publications

(82 reference statements)

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“…Hartmann's procedure should be performed in case of high risk of anastomotic dehiscence, and subtotal and total colectomy should be attempted in presence of cecal perforation or synchronous colonic neoplasms. [27] In our experience, we performed 6 right hemicolectomies with primary anastomosis for right colon cancer. For left colon cancer, we performed 2 Hartmann's procedures, 1 sigmoidectomy with temporary diverting ileostomy, and 2 decompressive colostomies.…”

Section: Discussionmentioning

confidence: 99%

Complicated colorectal cancer in nonagenarian patients: is it better not to perform anastomosis in emergency?

Simone

Ansaloni²,

Tarasconi³

et al. 2016

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Colorectal cancer (CRC) is predominantly a disease of elderly people. Cancer in nonagenarian patients presents an ethical dilemma for surgeons and oncologists, and management of this group of patients in emergency for complicated CRC is debated. Presently described is retrospective study reporting experience of 6 departments of emergency surgery with management of nonagenarian patients sent to emergency surgery for CRC complications. METHODS: Data concerning patients aged over 90 years hospitalized from January 2011 to June 2015 in 6 departments of emergency surgery for complicated CRC were retrospectively analyzed. Data were collected in a dedicated database. Statistical analysis was conducted using IBM software SPSS 22 (IBM Corp., Armonk, NY, USA); statistical significance was set at p=0.05. RESULTS: In the period of study,19 patients aged over 90 underwent surgery in emergency department for complicated CRC. Of the total, 52.63% were female, with sex ratio F:M of 1.11:1. Mean age was 92.52 years (range: 90-97 years; SD 1.49). Preoperative assessment of surgical risk was made using American Society of Anesthesiologists (ASA) score. There was no statistically significant difference in terms of in-hospital mortality between patients with ASA score ≤ 3 and patients with an ASA score >3. Primary anastomosis was performed in 6 of 19 patients (31.57%), all of whom had right-side colon cancer. Diverting stoma was created for 12 of 19 patients (63.15%). There was a statistically significant difference in incidence of postoperative complications between patients with right-side colon cancer and patients with left-side colon cancer (p=0.0498). Mean length of hospital stay was 12.78 days (range: 2-31 days; SD 6.31). In-hospital mortality rate was 21.05% (n=4). At follow up, overall survival was 47.36% (n=9). CONCLUSION: Elective surgery is the best way to manage CRC in all patients affected. Emergency surgery for CRC complications in patients over 90 is feasible with careful preoperative selection and evaluation of the patient. One-stage surgery is the best choice, in selected patients. Two-and three-stage surgery is indicated in case of peritonitis, for frail patients, for hemodynamically unstable patients. If there is high risk of anastomotic leakage, decompressive stoma is suggested as bridge to elective surgery, and in advanced neoplastic disease, as palliative procedure. In emergency setting, diverting stoma is a good surgical option in nonagenarian patients to decrease surgical risk, morbidity, and mortality; however, clinical randomized controlled trials are necessary to confirm this.

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Section: Discussionmentioning

confidence: 99%

Complicated colorectal cancer in nonagenarian patients: is it better not to perform anastomosis in emergency?

Simone

Ansaloni²,

Tarasconi³

et al. 2016

Ulus Travma Acil Cerrahi Derg

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“…Some researchers argued that resection and primary anastomosis can be safely used in emergent left colon resection (24,25 (29) stressed that Hartmann procedure should be preferred to loop colostomy. As a result, we believe that the surgical treatment to be applied for acute left-sided tumors should be decided according to the patient's general condition, the surgeon's experience and the hospital's conditions.…”

mentioning

confidence: 99%

An evaluation of treatment results of emergency versus elective surgery in colorectal cancer patients

Bayar

Yılmaz

Akıncı

et al. 2016

UCD

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Objective: Colorectal cancer is still one of the most common causes of cancer related deaths in the world despite improvements in diagnosis and treatment modalities, and application of community-based screening methods. Symptoms of colorectal cancer are non-specific and usually manifest following local progression. A number of patients with advanced stage colorectal cancer present to emergency departments with obstruction as the first sign of disease without any previous symptoms. This presentation is an indication for emergency surgery that has a high rate of morbidity and mortality. In this study, we aimed to determine the factors associated with early diagnosis and survival by comparing postoperative results of colorectal cancer patients who underwent surgery under emergency or elective situation. Material and Methods:Files of colorectal patients treated between 2009-2013 were retrospectively analyzed. Data on patient age, gender, operation type, intraoperative results, length of hospital stay, co-morbidities, postoperative complications and pathological results were evaluated and compared.Results: There was no statistical difference between groups in terms of age, gender, and pathology results (p>0.05). The difference between groups in terms of postoperative length of hospital stay, presence of co-morbid diseases, pathological stage, and postoperative complications was statistically significant (p<0.05). Length of hospital stay, advanced stage on admission, complications such as surgical site infection, evisceration, and anastomosis leakage rates were higher in patients in the emergency surgery group. Conclusion:Risk groups should be determined in order to diagnose colorectal cancer patients at an early stage while they are still asymptomatic, and this information should be incorporated into effective screening programs. This approach will be beneficial to treatment outcomes, complication rates, length of hospital stay, and survival and treatment results. INTRODUCTIONColorectal cancer (CRC) is one of the most frequent cancers with more than one million people worldwide being diagnosed with CRC annually, which is the most common gastrointestinal tract cancer (1). The majority of these neoplasms are endoluminal adenocarcinoma derived from the mucosa, and over 95% of CRC patients benefit from surgery or colonoscopic interventions for premalignant polyps with early diagnosis (2). Despite advances in diagnosis and treatment and dissemination of communitybased screening, colorectal cancer remains to be one of the main reasons of cancer-related deaths in the world (3).

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“…Низкие показатели 5-летней выживаемости, приведен-ные в настоящем исследовании, связаны с экстренны-ми хирургическими вмешательствами, выполненными Colorectal КОЛОПРОКТОЛОГИЯ 2' 2018 О р и г и н а л ь н ы е и с с л е д о в а н и я Л И Т Е Р А Т У Р А / R E F E R E N C E S на высоте ургентного осложнения не всегда в адекват-ном объеме, зависящем от типа выбранного оператив-ного вмешательства и степени выполнения онкологи-ческого радикализма. Полученные данные 5-летней выживаемости коррелируют с данными других авто-ров, изучавших отдаленные результаты хирургическо-го лечения осложненного КРР, которые составляют 10,0-39,6 % [5, [10][11][12][13][14]. В ходе исследования обнару-жилось, что в источниках литературы не представлены в полном объеме данные по отдаленным результатам экстренной хирургии рака ОК.…”

Section: Discussionunclassified

Emergency resections in patients with complicated rightand left-sided colon cancer: long-term outcomes

Щаева¹

2018

Onkol. koloproktol.

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Objective: to evaluate five-year overall and relapse-free survival in patients with complicated rightand left-sided colon cancer that underwent emergency resection.Materials and methods. The study included 501 patients with urgent complications of rightand left-sided colon cancer that underwent emergency resection. The data was obtained from an electronic register containing the information on patients with urgent complications of colorectal cancer treated in general and specialized surgical hospitals in Smolensk between 2001 and 2013 (13 years). We assessed fiveyear overall and relapse-free survival in these patients.Results. A total of 501 resections were performed during the study period. We observed significant differences in resection statuses of patients after emergency resection: the R1 resection status was more frequent in individuals with right-sided colon cancer compared to those with left-sided colon cancer (20.8 % vs. 6.9 %, p = 0.0002). Mean number of lymph nodes examined was 4.6 ± 2.0 in patients with right-sided cancer and 5.3 ± 3.0 in patients with left-sided cancer (p = 0.18). There were no differences in the number of patients receiving adjuvant treatment between the groups (p = 0.11). Patients with left-sided stage II/IIIB/IIIСcomplicated colon cancer demonstrated better overall and relapse-free survival than those with right-sided tumors of the same stages (overall survival: p = 0.007, p = 0.0002, p = 0.0001 for stages II, IIIB, IIIСrespectively; relapse-free survival: p = 0.005, p = 0.0003, p = 0.0002 for stages II, IIIB, IIIСrespectively).Conclusion. The observed differences in the outcomes of treatment for rightand left-sided complicated colon cancer can be explained by the fact that the majority of emergency resections for right-sided tumors were one-stage and were performed in general surgery hospitals. Patients with left-sided cancer underwent tumor removal on the second stage more often than those with right-sided cancer (32 % vs. 13 %). Treatment of patients with complicated colon cancer should be consistent, stepwise, and pathogenetically reasonable.

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Guidelines in the management of obstructing cancer of the left colon: consensus conference of the world society of emergency surgery (WSES) and peritoneum and surgery (PnS) society

Cited by 171 publications

References 59 publications

Complicated colorectal cancer in nonagenarian patients: is it better not to perform anastomosis in emergency?

Complicated colorectal cancer in nonagenarian patients: is it better not to perform anastomosis in emergency?

An evaluation of treatment results of emergency versus elective surgery in colorectal cancer patients

Emergency resections in patients with complicated rightand left-sided colon cancer: long-term outcomes

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