Should patients With obstructing colorectal cancer have proximal diversion?

Shwaartz, Chaya; Fields, Adam C.; Prigoff, Jake G.; Aalberg, Jeffrey; Divino, Celia M.

doi:10.1016/j.amjsurg.2016.08.005

Cited by 10 publications

(8 citation statements)

References 37 publications

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“…Shwaartz et al [13] found that three is no significant difference between the three groups according to the site of the tumor. In our study we found that sigmoid colon is mostly affected site and there is no significance between the three groups according the site of the tumor (P=0.298).…”

Section: Resultsmentioning

confidence: 95%

“…Shwaartz et al [13] found that there is a significant difference between primary anastomosis with and without fecal diversion in the age. According to our study, there was also a significant difference in the age of the two groups p value=0.004.…”

Section: Resultsmentioning

confidence: 99%

“…Shwaartz et al [13] suggest that proximal diversion in the setting of obstructed colorectal carcinoma may be associated with increased morbidity, specifically higher rates of complications and longer length of hospital stay. The management of patients with obstructed colorectal carcinoma should be based on patient state, surgeon experience and intraoperative findings.…”

Section: Resultsmentioning

confidence: 99%

“…However, when performing a primary anastomosis with diversion, we should take into account the significant risk for morbidities. Also they found that patients who underwent primary anastomosis with proximal diversion have significantly higher rates of negative outcomes such as wound sepsis, longer length of hospital stay and 30 day readmission [13]. In our study we found many complications such as DVT, seroma, wound infection, and anastomotic leakage in the three groups and there was no significance in the complications of the three groups (p value>0.05), we found also high rates of complication of stoma in group B such as constipation, obstruction, diarrhoea, parastomal hernia, flush stoma and skin maceration and there is a significant difference between the two groups regarding diarrhoea (p value=0.001).…”

Section: Resultsmentioning

confidence: 99%

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Assessment of Colonic Anastomosis after Surgical Management of Obstructed Left Colonic Cancer Performing Primary Repair with or without Proximal Diversion

Foda¹,

Alsharabasy²,

Gharieb³

et al. 2018

J Tumor Res

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Background: Up to 20% of patients with colorectal cancer present with obstruction. The goal of this study was to compare the short-term outcomes of patients with obstructing colon cancer who underwent resection and primary anastomosis with or without proximal diversion. Objective: This study was carried out in Surgery Department of Zagazig University Hospitals from February 2000 to February 2018 to compare the on-table irrigation and primary anastomosis versus proximal diversion with loop proximal diversion. Patients and methods: This study comprised 2525 patients who were divided into 2 groups: Group A included 2322 patients who have undergone on table lavage and primary anastomosis. Group B included 203 patients who have undergone primary anastomosis with proximal ileostomy. In our study, 1431 patients were males and 1094 patients were females. All patients were well prepared and investigated for selection of patients who can be operated. All patients were operated and discharged from the hospital and followed up in outpatient clinic of Zagazig University Hospitals, Surgery department. Results: As regard the age, there was a highly significant difference in the age of the two groups (p=0.004) while there was no significance in the sex of the studied groups (p=0.61). As regard the tumor location there was no significance (p=0.298). The intraoperative time was increased in case of on table irrigation with a significant difference (p=0.001). There was also a significant difference in the postoperative hospital stay (p=0.001). There was no significance regarding the postoperative complications of the studied groups expect stoma complications in case of diversion (p=0.001). Conclusion: On table colonic lavage and primary anastomosis is favored in surgical management of acute obstructed left sided colon cancer in low risk patients while in high risk older patients primary anastomosis with a covering stoma is preferred for fear of leakage and a covering loop ileostomy is preferred than loop colostomy.

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Section: Resultsmentioning

confidence: 95%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Assessment of Colonic Anastomosis after Surgical Management of Obstructed Left Colonic Cancer Performing Primary Repair with or without Proximal Diversion

Foda¹,

Alsharabasy²,

Gharieb³

et al. 2018

J Tumor Res

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“…Stomas can have a negative impact on the patient’s body image and quality of life (QOL). Additionally, diverting stoma formation in colorectal resection for OCC is related to increased postoperative complications, failure to wean off the ventilator, and longer hospital stays[ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Oncologic impact of colonic stents for obstructive left-sided colon cancer

Suzuki¹,

Tsujinaka²,

Sato³

et al. 2023

World J Clin Oncol

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Colonic stenting has had a significant positive impact on the management of obstructive left-sided colon cancer (OLCC) in terms of both palliative treatment and bridge-to-surgery (BTS). Notably, many studies have convincingly demonstrated the effectiveness of stenting as a BTS, resulting in improvements in short-term outcomes and quality of life, safety, and efficacy in subsequent curative surgery, and increased cost-effectiveness, whereas the safety of chemotherapy after stenting and the long-term outcomes of stenting as a BTS are controversial. Several studies have suggested an increased risk of perforation in patients receiving bevacizumab chemotherapy after colonic stenting. In addition, several pathological analyses have suggested a negative oncological impact of colonic stenting. In contrast, many recent studies have demonstrated that colonic stenting for OLCC does not negatively impact the safety of chemotherapy or long-term oncological outcomes. The updated version of the European Society of Gastrointestinal Endoscopy guidelines released in 2020 included colonic stenting as a BTS for OLCC as a recommended treatment. It should be noted that the experience of endoscopists is involved in determining technical and clinical success rates and possibly oncological outcomes. This review discusses the positive and negative impacts of colonic stenting on OLCC treatment, particularly in terms of oncology.

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Large Bowel Obstruction

Mowery

Spencer²

2022

The Acute Management of Surgical Disease

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Should patients With obstructing colorectal cancer have proximal diversion?

Cited by 10 publications

References 37 publications

Assessment of Colonic Anastomosis after Surgical Management of Obstructed Left Colonic Cancer Performing Primary Repair with or without Proximal Diversion

Assessment of Colonic Anastomosis after Surgical Management of Obstructed Left Colonic Cancer Performing Primary Repair with or without Proximal Diversion

Oncologic impact of colonic stents for obstructive left-sided colon cancer

Large Bowel Obstruction

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