THE SURGICAL MANAGEMENT OF LARGE BOWEL OBSTRUCTION IN PATIENTS WITH LEFT COLON AND RECTAL CANCER – A RETROSPECTIVE STUDY

Authors

  • M. DIACONESCU University of Medicine and Pharmacy of Craiova, Romania
  • A. NICOLAESCU University of Medicine and Pharmacy of Craiova, Romania
  • M. BICA University of Medicine and Pharmacy of Craiova, Romania
  • Georgiana GRAURE-COTOFANA University of Medicine and Pharmacy of Craiova
  • D.N. MARGARITESCU University of Medicine and Pharmacy of Craiova
  • Daniela MARINESCU University of Medicine and Pharmacy of Craiova
  • D. CARTU University of Medicine and Pharmacy of Craiova
  • A. PATRU Emergency County Hospital of Craiova, Romania
  • C. MIREA University of Medicine and Pharmacy of Craiova
  • S. PATRASCU University of Medicine and Pharmacy of Craiova
  • K. SAPALIDIS “Aristotle” University of Thessaloniki, Greece
  • V. SURLIN University of Medicine and Pharmacy of Craiova

Abstract

The optimal surgical attitude towards obstructed left colon and upper rectal cancer remains elusive, one of the main postoperative endpoints being to avoid the most dreaded complication of this type of procedures - the anastomotic leakage. Material and methods: We conducted a retrospective analysis of all patients with left colon and rectal cancer admitted and having emergency surgery performed in the surgical departments of the University County Hospital of Craiova, Romania, between 2001 and 2018. The timeline analysis showed an increasing interest for single-stage resection and anastomosis in the second decade (2011-2018) compared to the first decade of the study (28% vs. 11.2%). Results: The incidence of anastomotic leak for these types of procedures remained higher than for the two-stage procedure (15% vs. 4.8%), similar to the overall postoperative morbidity (30.3% vs. 20%) and mortality (3% vs. 1.1%). Postoperative morbidity and anastomotic leak rate were statistically higher in the single stage procedure group when compared with the two-stage procedure (p <0.05). Conclusions: Deciding between single-stage resection with anastomosis and a two-stage procedure requires a careful patient selection due to the relatively high risk of anastomotic leak in this specific category of patients.

Author Biographies

  • M. DIACONESCU, University of Medicine and Pharmacy of Craiova, Romania

    6th Surgical Department

  • A. NICOLAESCU, University of Medicine and Pharmacy of Craiova, Romania

    6th Surgical Department

  • M. BICA, University of Medicine and Pharmacy of Craiova, Romania

    6th Surgical Department

  • Georgiana GRAURE-COTOFANA, University of Medicine and Pharmacy of Craiova

    6th Surgical Department

  • D.N. MARGARITESCU, University of Medicine and Pharmacy of Craiova

    6th Surgical Department

  • Daniela MARINESCU, University of Medicine and Pharmacy of Craiova

    6th Surgical Department

  • D. CARTU, University of Medicine and Pharmacy of Craiova

    6th Surgical Department

  • A. PATRU, Emergency County Hospital of Craiova, Romania

    Department of Anesthesiology

  • C. MIREA, University of Medicine and Pharmacy of Craiova

    6th Surgical Department

  • S. PATRASCU, University of Medicine and Pharmacy of Craiova

    6th Surgical Department

  • K. SAPALIDIS, “Aristotle” University of Thessaloniki, Greece

    3rd Surgical Department

  • V. SURLIN, University of Medicine and Pharmacy of Craiova

    6th Surgical Department

References

1. Jung SH, Kim JH. Comparative study of postoperative complications in patients with and without an obstruction who had left-sided colorectal cancer and underwent a single-stage operation after mechanical bowel preparation. Ann Coloproctol 2014; 30(6): 251-258.
2. Webster PJ, Aldoori J, Burke DA. Optimal management of malignant left-sided large bowel obstruc-tion: do international guidelines agree? World J Emerg Surg 2019; 14: 23 / doi: 10.1186/ s13017-019-0242-5.
3. Min CK, Kim HO, Lee D, et al. Obstructive Left Colon Cancer Should Be Managed by Using a Subtotal Colectomy Instead of Colonic Stenting. Ann Coloproctol 2016; 32(6): 215-220.
4. Nguyen DA, Mai-Phan TA, Do PTT, Thai TT. Emergency surgery for obstructed colorectal cancer in Vietnam. Asian J Surg 2020; 43(6): 683-689.
5. Kim JS, Hur H, Min BS, Sohn SK, Cho CH, Kim NK. Oncologic outcomes of self-expanding metallic stent insertion as a bridge to surgery in the management of left-sided colon cancer obstruction: comparison with nonobstructing elective surgery. World J Surg 2009; 33(6): 1281-1286.
6. Runkel NS, Hinz U, Lehnert T, Buhr HJ, Herfarth Ch. Improved outcome after emergency surgery for cancer of the large intestine. Br J Surg 1998; 85(9): 1260-1265.
7. Vuik FE, Nieuwenburg SA, Bardou M, et al. Increasing incidence of colorectal cancer in young adults in Europe over the last 25 years. Gut 2019; 68(10): 1820-1826.
8. Deen KI, Madoff RD, Goldberg SM, Rothenberger DA. Surgical management of left colon obstruction: the University of Minnesota experience. J Am Coll Surg 1998; 187(6): 573-576.
9. Väyrynen JP, Tuomisto A, Väyrynen SA, et al. Preoperative anemia in colorectal cancer: relationships with tumor characteristics, systemic inflammation, and survival. Sci Rep 2018; 8(1): 1126 / doi: 10.1038/s41598-018-19572-y.
10. Krstic S, Resanovic V, Alempijevic T, et al. Hartmann’s procedure vs. loop colostomy in the treatment of obstructive rectosigmoid cancer. World J Emerg Surg 2014; 9(1): 52 / doi: 10.1186/ 1749-7922-9-52.
11. Miron A, Giulea C, Gologan S, Eclemea I. Evaluation of efficacy of mechanical bowel preparation in colorectal surgery. Chirurgia (Bucur) 2008; 103(6): 651-658.
12. Enciu O, Calu V, Angelescu M, Nădrăgea MA, Miron A. Emergency Surgery and Oncologic Resec-tion for Complicated Colon Cancer: What Can We Expect? A Medium Volume Experience in Romania. Chirurgia (Bucur) 2019; 114(2): 200-206.
13. Baer C, Menon R, Bastawrous S, Bastawrous A. Emergency Presentations of Colorectal Cancer. Surg Clin North Am 2017; 97(3): 529-545.
14. Kronborg O, Backer O, Sprechler M. Acute obstruction in cancer of the colon and rectum. Dis Colon Rectum 1975; 18(1): 22-27.
15. Ansaloni L, Andersson RE, Bazzoli F, et al. 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. World J Emerg Surg 2010; 5: 29 / doi: 10.1186/1749-7922-5-29.
16. Amelung FJ, Mulder CL, Verheijen PM, Draaisma WA, Siersema PD, Consten EC. Acute resection versus bridge to surgery with diverting colostomy for patients with acute malignant left sided colonic obstruction: Systematic review and meta-analysis. Surg Oncol 2015; 24(4): 313-321.
17. Hyman N, Manchester TL, Osler T, Burns B, Cataldo PA. Anastomotic leaks after intestinal anasto-mosis: it's later than you think. Ann Surg 2007; 245(2): 254-258.
18. Ion D, Stoian RV, Păduraru DN, Bolocan A, Serban MB. Certitudes and controversy regarding neural elements preservation in total mesorectal excision technique (ETM). Chirurgia (Bucur). 2012; 107(2): 231-236.
19. Biondo S, Kreisler E, Millan M, et al. Impact of surgical specialization on emergency colorectal surgery outcomes. Arch Surg 2010; 145(1): 79-86.
20. Paduraru DN, Coman F, Ozon EA, et al. The use of nutritional supplement in Romanian patients-attitudes and beliefs. Farmacia 2019; 67(6): 1060-1065.
21. Nobuhara H, Yanamoto S, Funahara M, et al. Effect of perioperative oral management on the preven-tion of surgical site infection after colorectal cancer surgery: A multicenter retrospective analysis of 698 patients via analysis of covariance using propensity score. Medicine (Baltimore) 2018; 97(40): e12545 / doi: 10.1097/MD.0000000000012545.
22. Dotan E, Browner I, Hurria A, Denlinger C. Challenges in the management of older patients with colon cancer. J Natl Compr Canc Netw 2012; 10(2): 213-225.

Additional Files

Published

2021-06-30