Influence of tumour site on presentation, management and subsequent outcome in large bowel cancer

Aldridge, M. C.; Rw, Phillips; Hittinger, Rosemary; Fry, J. S.; Fielding, L P

doi:10.1002/bjs.1800730829

Cited by 127 publications

(88 citation statements)

References 26 publications

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“…Localization in the splenic flexure is observed in 4% of the patients, but this rarest localization is associated with obstruction in half of the cases. [2] Admission with acute obstruction in patients with colon cancers has been reported at rates up to 29% in different series. [3,4] The most frequent etiological factor in emergent colonic surgeries is malignancies, constituting approximately 60% of all mechanical obstructions.…”

Section: Resultsmentioning

confidence: 99%

Is Total-subtotal Colectomy and Primary Anastomosis Good Treatment Alternatives in Malignant Obstructive Lesions of the Left Colon?

Arslan¹,

Eryılmaz²,

Okuş³

et al. 2012

Ulus Travma Acil Cerrahi Derg

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AMAÇBu çalışmada, sol kolonun tıkayıcı malign lezyonlarında total-subtotal kolektomi anostomoz ile diğer cerrahi tedavi yöntemleri karşılaştırıldı. GEREÇ VE YÖNTEMÇalışmaya Konya Eğitim ve Araştırma Hastanesine 2004-2007 yılları arasında transvers kolon distalinde tıkanıklık bulguları ile başvuran ve cerrahi tedavi uygulanan hastalar dahil edildi. Hastalar cerrahi prosedüre göre üç gruba ayrıl-dı. Bunlar: Grup I: Hartmann prosedürü; Grup II: Rezeksiyon, anostomoz ve saptırıcı ileostomi; Grup III: Total veya subtotal kolektomi ve primer anastomoz. Hastaların dosyaları geriye dönük olarak incelendi. BULGULARAltmış iki hastanın yaş ortalaması 64 (dağılım, 38-89 yaş) idi. Birinci grupta 15, ikinci grupta 21, üçüncü grupta 26 hasta vardı. Gruplar arasında yaş ortalamaları, cinsiyet, ASA skoru ve tümör evresi bakımından anlamlı fark yoktu. Çalışma grupları arasında ameliyat süresi ve ameliyat sonrası morbidite, mortalite ve beş yıllık sağkalım açısından anlamlı fark yoktu, ancak hastanede kalma süresi ve tedavi maliyetleri açısından Grup I ve Grup II'ye göre Grup III'de anlamlı olarak düşüktü. SONUÇDeneyimli cerrahlar tarafından yapılan total-subtotal kolektomi ve primer anostomozun diğer bir veya iki aşmalı cerrahi prosedürlere göre daha iyi bir alternatiftir.Anahtar Sözcükler: Sol kolon tıkayıcı tümörlerinin tedavisi, total veya subtotal kolektomi; Hartmann prosedürü; rezeksiyon; saptı-rıcı ileostomi.

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Section: Resultsmentioning

confidence: 99%

Is Total-subtotal Colectomy and Primary Anastomosis Good Treatment Alternatives in Malignant Obstructive Lesions of the Left Colon?

Arslan¹,

Eryılmaz²,

Okuş³

et al. 2012

Ulus Travma Acil Cerrahi Derg

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“…Hallbook et al demonstrated in 30 patients that the side of the bowel cm above the cut proximal end has a better blood supply than the cut end. 8,13,17 The authors felt this supported the use of aside-to-end technique and hence colonic pouches, but did not comment on a difference in flow depending on whether the ascending left colic artery was preserved. Hall et al demonstrated that sigmoid colon tissue oxygen tension decreased following inferior mesenteric artery origin ligation in an elegant study involving 62 patients.…”

Section: Resultsmentioning

confidence: 99%

Splenic flexure cancer optimum level of vessel ligation

Rao¹,

Reddy²,

Chilukoti³

2017

Int Surg J

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Background: Incidence of splenic flexure carcinoma is very low in colorectal cancer but often time presented in an advanced stage with high risk of obstruction, contributing poor prognosis. Aim of the study was to investigate the adequacy of vessel ligation in SFC in term of overall survival.Methods: 35 patients diagnosed with splenic flexure carcinoma enrolled and analyzed, patients categorized based on the level of vessel ligation as group-A, left branch of middle colic (LMA) and left colic artery division (LCA) compared, group-B, LCA and marginal of middle colic artery (MMC).Results: CEA marker was not significantly changed post-operatively, as it was within normal range preoperatively at an average of 9-12 µg/ml. There is no significance in staging of tumors in all stages, and recurrence of tumor is present in 5 in group A. Radical margins both proximal and distal ends are not significant. Tumor clearance achieved successfully in both arms in term of proximal margin achieved at 7.9±3.5cm in groups B and 8.3±4.1 cm in group A, p = 0.312. Distal margin reported at 8.7±4.1 cm and 8.9±3.98cm, p = 0.58, respectively. Lymph nodes are positive in group-A and group-B without any significance. Tumor size or diameter ranging from 5.1±3.1 in group-A and 4.76±3.8 in group-B. According to the cell differentiation, majority of the tumor grade turned out to be moderately differentiated cancer, rated at 14 patients (40.1%) in group A and 13 patients (37.1%) in group B. one patients found to be well or poorly differentiated cell tumors in group-A. Overall p-values were insignificant in regards tumor cell differentiation in both groups, p = 0.213. Incidence of lympho-vascular invasion reached only 3 (8.5%) vs. 4 patients (11.2%), p = 0.562, in A and B group.Conclusions: Higher level of vessel ligation has no added significance in overall outcome, but has role to lower the risk of recurrence rate in Splenic flexure carcinoma patients.

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“…Cancer of splenic flexure is rare, comprising only 2% to 5% of all colorectal cancers (7)(8)(9)(10). Very few studies have specifically investigated the use of laparoscopic left hemicolectomy for cancer (11).…”

Section: Discussionmentioning

confidence: 99%

“…The optimal surgical treatment for left hemicolon cancer remains controversial. Some surgeons have argued that subtotal colectomy or extended right hemicolectomy improves oncological outcome (7,13). However, other studies have demonstrated that the prognosis for left hemi-colon cancer is no worse than for other colon cancers, and that left hemi-colectomy is sufficient for a satisfactory oncological outcome (8,9,14).…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic-assisted radical left hemicolectomy for colon cancer

Han¹,

Min²

2016

J. Vis. Surg.

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IntroductionLaparoscopic surgery has been enthusiastically applied to the resection of colorectal cancer for more than many years. Nowadays, more and more colorectal surgeons believe that laparoscopic approach gains quicker functional recovery, achieves comparable (1-3), and even better oncologic results (4,5) for the treatment of patients with colorectal cancer. However, the safety of laparoscopic left hemicolectomy for cancer remains to be established, owing to its exclusion from previous randomized controlled trials. Laparoscopic left hemi-colectomy, involving the takedown of splenic flexure, has been more challenging than the other laparoscopic colorectal procedures. Because there is the technical variability between colorectal surgeons, the clinical trial of laparoscopic left hemi-colectomy which required the takedown of splenic flexure for the curative resection of cancers and tension-free colonic anastomosis has been rare. This video article aims to describe safe and feasibility of laparoscopic left hemi-colectomy, authors would like to share the surgical techniques with you via a case of descending colonic neoplasm who underwent the laparoscopic left hemi-colectomy ( Figure 1) (6). DiscussionCancer of splenic flexure is rare, comprising only 2% to 5% of all colorectal cancers (7-10). Very few studies have specifically investigated the use of laparoscopic left hemicolectomy for cancer (11). However, surgical approaches for transverse or descending colon cancer vary considerably depending on the relative location of the tumor. Thus, the purpose of this video article is to show safe and efficiency for the tumor locates in the left hemi-colon.Laparoscopic left hemi-colectomy is suitable for the tumors locate in distal a third of the transverse colon, splenic flexure, descending colon and upper sigmoid colon. Left hemi-colectomy was defined as a procedure requiring division of the left colic and the left branch of the middle colic vessels at their origins. Generally, left hemi-colectomy was carried out for stage I/II/III tumors. Briefly, the surgeon and camera operator stood on the right side of the patient, with the first assistant positioned to the left or between the legs of the patient. Medial-to-lateral retroperitoneal dissection was performed to allow division of the left colic artery. The inferior mesenteric vein was divided near the inferior border of the pancreas. The omentum was then transected to allow entry into the omental bursa (lesser sac) and mobilization of the splenic flexure. The left branch of the middle colic vessels was identified at the inferior border of the pancreas and divided at its origin. The specimen was extracted through the camera port, which was extended to about 4-5 cm, and the anastomosis was formed extracorporeally by functional end-to-end anastomosis or intracorporeally by side-to-side anastomosis using linear staplers.The blood supply to distal a third of the transverse colon, splenic flexure, descending colon and upper sigmoid colon has been shown to vary between patient...

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Influence of tumour site on presentation, management and subsequent outcome in large bowel cancer

Cited by 127 publications

References 26 publications

Is Total-subtotal Colectomy and Primary Anastomosis Good Treatment Alternatives in Malignant Obstructive Lesions of the Left Colon?

Is Total-subtotal Colectomy and Primary Anastomosis Good Treatment Alternatives in Malignant Obstructive Lesions of the Left Colon?

Splenic flexure cancer optimum level of vessel ligation

Laparoscopic-assisted radical left hemicolectomy for colon cancer

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