Obstructive Left Colon Cancer Should Be Managed by Using a Subtotal Colectomy Instead of Colonic Stenting

Abstract

PurposeThis study compared a subtotal colectomy to self-expandable metallic stent (SEMS) insertion as a bridge to surgery for patients with left colon-cancer obstruction.MethodsNinety-four consecutive patients with left colon-cancer obstruction underwent an emergency subtotal colectomy or elective SEMS insertion between January 2007 and August 2014. Using prospectively collected data, we performed a retrospective comparative analysis on an intention-to-treat basis.ResultsA subtotal colectomy and SEMS insertion were attempted in 24 and 70 patients, respectively. SEMS insertion technically failed in 5 patients (7.1%). The mean age and rate of obstruction in the descending colon were higher in the subtotal colectomy group than the SEMS group. Sex, underlying disease, American Society of Anesthesiologists physical status, and pathological stage showed no statistical difference. Laparoscopic surgery was performed more frequently in patients in the SEMS group (62 of 70, 88.6%) than in patients in the subtotal colectomy group (4 of 24, 16.7%). The overall rate of postoperative morbidity was higher in the SEMS group. No Clavien-Dindo grade III or IV complications occurred in the subtotal colectomy group, but 2 patients (2.9%) died from septic complications in the SEMS group. One patient (4.2%) in the subtotal colectomy group had synchronous cancer. The total hospital stay was shorter in the subtotal colectomy group. The median number of bowel movements in the subtotal colectomy group was twice per day at postoperative 3–6 months.ConclusionA subtotal colectomy for patients with obstructive left-colon cancer is a clinically and oncologically safer, 1-stage, surgical strategy compared to SEMS insertion as a bridge to surgery.

Safety of subtotal or total colectomy with primary anastomosis compared to Hartmann procedure for left-sided colon cancer obstruction or perforation

“…Other studies have reported synchronous cancer in 3%-11% of patients who undergo PA for left-sided colon cancer [15,16]. PA might be an oncologically safe strategy for patients with synchronous tumor [13].…”

“…However, colonic stent has several disadvantages such as perforation, re-obstruction, and stent migration [11,12]. Technical and clinical failure rates of colonic SEMS are 20%-30% [13]. A randomized controlled trial has reported a technical failure rate of 53.3% [14].…”

“…A randomized controlled trial has reported a technical failure rate of 53.3% [14]. Some reports have suggested that SEMS insertion is associated with adverse oncological outcomes [13]. PA has been proposed as an effective surgical procedure to treat patients with left-sided colon cancer.…”

Evaluation of one-stage management of left side cancer colon

“…Min et al, reported that the mean hospital stay was 12 days (range 10-15 days). 10 Andreano et al, showed that all patients with a regular postoperative course have had no more than 10 days of hospitalization except for those who suffered postoperative ileus which solved after no more 15 days. 11 In this study, 90% of cases had adenocarcinoma and 10% had mucinous adenocarcinoma.…”

Comparison of a Subtotal Colectomy With Self-Expandable Metallic Stent in the Management of Patients With Obstructive Left Colon Cancer

“…A subtotal colectomy can treat synchronous tumors in the proximal colon, reduce total hospital stays, and avoid oncologic deterioration from colonic stenting, as bowel function is preserved. Preoperative SEMS insertion should be considered only for patients with rectal or rectosigmoid junction cancer and patients for whom minimally invasive surgery is planned [10]. …”