Surgical Management of Complicated Colon Cancer

Lee-Kong, Steven A.; Lisle, David

doi:10.1055/s-0035-1564621

Cited by 17 publications

(12 citation statements)

References 27 publications

(27 reference statements)

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“…The small intestine and the bladder are reported as the top 2 frequently affected organs in locally advanced CC (incidence rates are as high as 48% and 50%, respectively). 23 They are also the organs most commonly removed in the MVR (resection rates are 31.6% and 27.0%, respectively). 5 In our previous study, the bladder appeared as the most commonly involved organ.…”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant chemoradiotherapy followed by surgery in patients with unresectable locally advanced colon cancer: a prospective observational study

Chang¹,

Yu²,

Xiao³

et al. 2018

OTT

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BackgroundThe prognosis of locally unresectable colon cancer (CC) is poor. This prospective observational study aimed to further evaluate the feasibility and efficacy of neoadjuvant chemoradiotherapy (NACRT) followed by surgery in these patients.Patients and methodsWe consecutively enrolled patients who were diagnosed with locally unresectable CC from November 2010 to March 2017, and received NACRT followed by surgery. The data of all the patients were collected prospectively. The R0 resection, down-stage and pathologic complete response (pCR) rates were calculated to evaluate the short-term treatment effects. The overall survival (OS) was used to evaluate the long-term outcome. The incidence of NACRT-related acute toxicities and postsurgical complications were used to assess the safety.ResultsA total of 60 patients were eligible for analysis, including 57 (95.0%) patients who attained resectability after NACRT. Among patients managed with surgery, 49 cases (86.0%) achieved R0 resection, and 15 cases (26.3%) achieved pCR. Down T stage was seen in 47 cases (82.5%), and down N stage was seen in 53 cases (93.0%). After a median follow-up time of 26 months, the OS appeared as 76.7%. The most common grade 3/4 NACRT-related toxicity was myelosuppression (incidence, 20.0%). The incidence of grade 3/4 surgery-related complication was 7.0%.ConclusionNACRT might be a safe and effective choice for patients with locally unresectable CC to improve treatment effects, long-term survival and life quality, though further validation is needed.

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Section: Discussionmentioning

confidence: 99%

Neoadjuvant chemoradiotherapy followed by surgery in patients with unresectable locally advanced colon cancer: a prospective observational study

Chang¹,

Yu²,

Xiao³

et al. 2018

OTT

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“…Many palliative and curative procedures may be considered. However, primary excision of the tumor is the treatment of choice for the patient as possible [9].…”

Section: Resultsmentioning

confidence: 99%

“…In the past decade, primary resection and anastomosis was a popular procedure over Hartman's procedure in low-risk cases [9]. Often, primary resection and anastomosis is covered by a diverting loop ileostomy to prevent the morbidity and mortality associated with anastomotic leakage [10].…”

Section: Resultsmentioning

confidence: 99%

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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“…Emergency surgery for complicated colon cancer can represent a trouble for the surgeon, who could come across the necessity to balance the importance of an adequate oncologic resection with the opportunity of a quick control of the septic source and obtaining the hemodynamic stabilization of the patient [ 3 , 4 ]. This is why emergency surgery can be an obstacle to reach the benchmark of 12 nodes with an accurate lymphadenectomy, in addition to all other variables that can influence the nodal harvesting.…”

Section: Introductionmentioning

confidence: 99%

Evaluation on prognostic efficacy of lymph nodes ratio (LNR) and log odds of positive lymph nodes (LODDS) in complicated colon cancer: the first study in emergency surgery

et al. 2018

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BackgroundLymph node involvement is one of the most important prognostic factors in colon cancer. Twelve is considered the minimum number of lymph nodes necessary to retain reliable tumour staging, but several factors can potentially influence the lymph node harvesting. Emergent surgery for complicated colon cancer (perforation, occlusion, bleeding) could represent an obstacle to reach the benchmark of 12 nodes with an accurate lymphadenectomy. So, an efficient classification system of lymphatic involvement is crucial to define the prognosis, the indication to adjuvant therapy and the follow-up. This is the first study with the aim to evaluate the efficacy of lymph nodes ratio (LNR) and log odds of positive lymph nodes (LODDS) in the prognostic assessment of patients who undergo to urgent surgery for complicated colonic cancer.MethodsThis is a retrospective study carried out on patients who underwent urgent colonic resection for complicated cancer (occlusion, perforation, bleeding, sepsis). We collected clinical, pathological and follow-up data of 320 patients. Two hundred two patients met the inclusion criteria and were distributed into three groups according to parameter N of TNM, LNR and LODDS. Survival analysis was performed by Kaplan-Meier curves, investigating both overall survival (OS) and disease-free survival (DFS).ResultsThe median number of harvested lymph nodes was 17. In 78.71% (n = 159) of cases, at least 12 lymph nodes were examined. Regarding OS, significant differences from survival curves emerged for ASA score, surgical indication, tumour grading, T parameter, tumour stage, N parameter, LNR and LODDS. In multivariate analysis, only LODDS was found to be an independent prognostic factor.Concerning DFS, we found significant differences between survival curves of sex, surgical indication, T parameter, tumour stage, N parameter, LNR and LODDS, but none of these confirmed its prognostic power in multivariate analysis.ConclusionsWe found that N, LNR and LODDS are all related to 5-year OS and DFS with statistical significance, but only LODDS was found to be an independent prognostic factor for OS in multivariate analysis.

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Surgical Management of Complicated Colon Cancer

Cited by 17 publications

References 27 publications

Neoadjuvant chemoradiotherapy followed by surgery in patients with unresectable locally advanced colon cancer: a prospective observational study

Neoadjuvant chemoradiotherapy followed by surgery in patients with unresectable locally advanced colon cancer: a prospective observational study

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

Evaluation on prognostic efficacy of lymph nodes ratio (LNR) and log odds of positive lymph nodes (LODDS) in complicated colon cancer: the first study in emergency surgery

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