Colonic Endolumenal Stenting Devices and Elective Surgery Versus Emergency Subtotal/Total Colectomy in the Management of Malignant Obstructed Left Colon Carcinoma
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Traditionally, left-sided acute bowel obstruction is treated by a staged procedure because immediate resection and anastomosis in a massive distended and unprepared colon carries a high complication rate. Total abdominal colectomy is a one-stage procedure that will remove synchronous proximal neoplasms, reduce the risk of subsequent metachronous tumor, and avoid stoma. Colorectal stents are being used for palliation and as a bridge to surgery in obstructing colorectal carcinoma, making elective surgery straightforward, enabling easily mobilization and resection of the colon with a possible trend toward reduction in postoperative complication rates compared to emergency surgery. The purpose of this work was to compare the procedures of endoscopic stenting followed by elective colectomy versus total abdominal colectomy and ileorectal anastomosis in the management of acute obstructed carcinoma of the left colon as regards feasibility, safety, and clinical outcomes
From January 2009 through May 2012, 60 patients were randomized to either emergency stenting followed by elective resection (ESER group) or total abdominal colectomy and ileorectal anastomosis (TACIR group).
Twenty nine patients (96.7 %) had successful stenting and underwent elective surgery 7–10 days later (ESER group). Postoperative complications were encountered in four patients in the ESER group compared to 15 patients in the TACIR group (p = 0.012). Anastomotic leakage was encountered in one patient (3.3 %) in the TACIR group. There were no operative mortalities in the present study. Within the first three postoperative months, the TACIR group patients had significantly more frequent bowel motions per day compared to the ESER group patients although (p = 0.013). In both study groups, the follow-up duration ranged from 6 to 40 months with a median of 18 months. Recurrent disease was encountered in five patients (17.2 %) in the ESER group compared to four patients (13.3 %) in the TACIR group (p = 0.228).
Both techniques are feasible, safe, and produce comparable oncological outcomes. However, endoscopic stenting followed by elective resection was associated with significantly less postoperative complications and bowel motions per day.
- Boyle P. Some recent developments in the epidemiology of colorectal cancer. In: Bleiberg HRP, Wilke H-J, editors. Management of colorectal cancer. London: Martin Dunitz; 1998. p. 19–34.
- Ohman U. Prognosis in patients with obstructing colorectal carcinoma. Am J Surg 1982;143:742–7. CrossRef
- Deans GT, Krukowski ZH, Irwin ST. Malignant obstruction of the left colon. Br J Surg 1994;81:1270–6. CrossRef
- Riedl S, Wiebelt H, Bergmann U, Hermanek P Jr. Postoperative complications and fatalities in surgical therapy of colon carcinoma. Results of the German multicenter study by the Colorectal Carcinoma Study Group. Chirurg 1995;66:597–606.
- Clark J, Hall A, Mussa AR . Treatment of obstructing cancer of the colon and rectum. Surg Gynec Obstet. 1975; 141: 541–544.
- Carson SN, Poticha SM, Shields TW. Carcinoma obstructing the left side of the colon. Arch Surg. 1977; 122: 523–526. CrossRef
- Deutsh AA, Zelikovski A, Strenberg A, Reiss R. One-stage subtotal-colectomy with anastomosis for obstructing carcinoma of the left colon. Dis. Colon rectum 1983; 26: 227–230. CrossRef
- McArdle CS, Hole DJ. Emergency presentation of colorectal cancer is associated with poor 5 year survival. British Journal of Surgery 2004;91(5):605–9. CrossRef
- Setti Carraro P, Segala M, Cesana B, Tiberio G. Obstructing colonic cancer: failure and survival over a ten-year follow-up after one-stage curative surgery. Diseases of the Colon and Rectum 2001;44(2):243–50. CrossRef
- Runkel NS, Hinz U, Lehnert T, Buhr HJ, Herfarth Ch. Improved outcome after emergency surgery for cancer of the large intestine. British Journal of Surgery 1988;85(9):1260–5. CrossRef
- Mitry E, Barthod F, Penna C, Nordlinger B. Surgery for colon and rectal cancer. Best Pract Res Clin Gastroenterol 2002;16:253–65. CrossRef
- Pearce NW, Scott SD, Karran SJ. Timing and method of reversal of Hartmann’s procedure. Br J Surg 1992;79:839–41 CrossRef
- Wong RW, Rappaport WD, Witzke DB, Putnam CW, Hunter GC. Factors influencing the safety of colostomy closure in the elderly. J Surg Res 1994;57:289–92. CrossRef
- Nugent KP, Daniels P, Stewart B, Patankar R, Johnson CD. Quality of life in stoma patients. Dis Colon Rectum 1999;42: 1569–74. CrossRef
- Sprangers MA, Taal BG, Aaronson NK, te Velde A. Quality of life in colorectal cancer. Stoma vs. nonstoma patients. Dis Colon Rectum 1995;38:361–9. CrossRef
- Londono-Schimmer EE, Leong AP, Phillips RK. Life table analysis of stomal complications following colostomy. Dis Colon Rectum 1994;37:916–20. CrossRef
- Park JJ, Del Pino A, Orsay CP, Nelson RL, Pearl RK, Cintron JR, et al. Stoma complications: the Cook County Hospital experience. Dis Colon Rectum 1999;42:1575–80. CrossRef
- Fielding LP, Stewart-Brown S, Blesovsky L. Large-bowel obstruction caused by cancer: a prospective study. BMJ 1979;2: 515–17. CrossRef
- Carson SN, Poticha SM, Shields TW. Carcinoma obstructing the left side of the colon. Arch Surg 1977;112: 523–26. CrossRef
- Scott NA, Jeacock J, Kingston RD. Risk factors in patients presenting as an emergency with colorectal cancer. British Journal of Surgery 1995;82(3):321–3. CrossRef
- Kulah B, Gulgez B, Ozmen M, Ozer M, Coskun F. Emergency bowel surgery in the elderly. Turkish Journal of Gastroenterology 2003;14(3):189–93.
- Phillips RKS, Hittinger R, Fry Js, Fielding LP. Malignant large bowel obstruction. Br. J. Surg. 1985; 72: 296–302. CrossRef
- Deans GT, Krukowski ZH, Irwin ST. Malignant obstruction of the left colon Br. J. Surg. 1994; 81: 1270–1276.
- Naraynsingh V, Rampaul R, Maharaj D, Kuruvilla T, Ramcharan K, Pouchet B. Prospective study of primary anastomosis without colonic lavage for patients with an obstructed left colon. Br. J. Surg. 1999; 86: 1341–1343. CrossRef
- Hsu TC. One-stage resection and anastomosis for acute obstruction of the left colon. Dis. Colon Rectum 1998; 42 : 28–32. CrossRef
- Mucci SH, Tuech JJ, Brehant O, Lermite E, Bergamaschi R, Pessaux P, Arnaud JP. Emergency subtotal/total colectomy in the management of obstructed left colon carcinoma. Int J Colorectal Dis 2006; 21: 538–541. CrossRef
- Hsu TC. Comparison of one stage resection and anastomosis of acute complete obstruction of left and right colon. Am. J. Surg 2005; 189: 384–387. CrossRef
- Lim JF, Tang CL, Seow-Choen F, Heah SM. Prospective, randomized trial comparing intraoperative colonic irrigation with manual decompression only for obstructed left-sided colorectal cancer. Dis Colon Rectum 2005; 48: 205–209. CrossRef
- The SCOTIA Study group. Single-stage treatment for malignant left-sided colonic obstruction: a prospective randomized clinical trial comparing subtotal colectomy with segmental resection following intra-operative irrigation. Br. J. Surg. 1995; 82: 1622–7. CrossRef
- Dohmoto M. New method: endoscopic implantation of rectal stent in palliative treatment of malignant stenosis. Endoscopia Digestiva 1991;3:1507–12.
- Mainar A, Tejero E, Maynar M, Ferral H, Castaneda- Zuniga W. Colorectal obstruction: treatment with metallic stents. Radiology 1996;198:761–4.
- Farrell JJ, Carr-Locke DC. Metal enteral stents: an endoscopist’s perspective. Seminars in Interventional Radiology 2001;18:327–37. CrossRef
- Baron TH, Dean PA, Yates MR 3rd, Canon C, Koehler RE. Expandable metal stents for the treatment of colonic obstruction: techniques and outcomes. Gastrointest Endosc 1998;47:277–86. CrossRef
- Mainar A, De Gregorio Ariza MA, Tejero E, Tobio R, Alfonso E, Pinto I, et al. Acute colorectal obstruction: treatment with self expandable metallic stents before scheduled surgery—results of a multicenter study. Radiology 1999;210:65–9.
- Keymling M. Colorectal stenting. Endoscopy 2003;35:234–8. CrossRef
- Baron TH. Colorectal stents. Tech Gastrointestinal Endosc 2003; 5: 183–90
- Tiemey W, Chuttani R, Croffie J, et al. Enteral stents. Gastrointestinal Endosc 2006; 63: 920–6 CrossRef
- Baron TH. Minimizing endoscopic complications: endoluminal stents. Gastrointestinal Endosc Clin N Am 2007;17: 83–104. CrossRef
- Riedl S, Wiebelt H, Bergmann U, Hermanek P Jr. Post-operative komplikationen und letalitat in der chirurgishen Therapies des Coloncarcinoms. Cbirurg 1995; 66: 597–606.
- Khot UP, Wenk Lang A, Muraliu K, Parker MC. Systematic review of the efficacy and safety of colorectal stents. Br J Surg 2002;89:1096–1102. CrossRef
- Arnaud J, Bergamaschi R. Emergency subtotal/total colectomy with anastomosis for acutely obstructed carcinoma of the left colon. Diseases of the Colon and Rectum 1994; 37(7): 685–8. CrossRef
- Halevy A, Levi J, Orda R. Emergency subtotal colectomy. A new trend for treatment of obstructing carcinoma of the left colon. Annals of Surgery 1989; 210(2):220–3. CrossRef
- Reemst P, Kulipers H, Wobbes T. Management of left-sided colonic obstruction by subtotal colectomy and ileocolic anastomosis. European Journal of Surgery 1998; 164(7): 537–40.
- Colonic Endolumenal Stenting Devices and Elective Surgery Versus Emergency Subtotal/Total Colectomy in the Management of Malignant Obstructed Left Colon Carcinoma
Journal of Gastrointestinal Surgery
Volume 17, Issue 6 , pp 1123-1129
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Malignant colonic obstruction
- Colorectal cancer
- Ileorectal anastomosis
- Anterior resection
- Self-expanding metal stents
- Industry Sectors