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Prospective, Controlled, Randomized Study of Intraoperative Colonic Lavage Versus Stent Placement in Obstructive Left-sided Colonic Cancer

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Abstract

Background

The main aim of this study was to compare short-term results and long-term outcomes of patients who underwent intraoperative colonic lavage (IOCL) with primary anastomosis with those who had stent placement prior to scheduled surgery for obstructive left-sided colonic cancer (OLCC).

Methods

We conducted a prospective, controlled, randomized study of patients diagnosed with OLCC. Patients were divided into two groups: stent and deferred surgery (group 1) and emergency IOCL (group 2). Demographic variables, risk prediction models, postoperative morbidity and mortality, staging, complications due to stent placement, surgical time, clinical follow-up, health costs, and follow-up of survival were recorded.

Results

Twenty-eight patients (15 group 1 and 13 group 1) were enrolled. The study was suspended upon detecting excess morbidity in group 2. The two groups were homogeneous in clinical and demographic terms. Overall morbidity in group 1 was 2/15 (13.3%) compared with 7/13 (53.8%) in group 2 (p = 0.042). None of the 15 patients in group 1 presented anastomotic dehiscence compared with 4/13 (30.7%) in group 2 (p = 0.035). Surgical site infection was detected in 2 (13.3%) patients in group 1 and in 6 (46.1%) in group 2 (p = 0.096). Postoperative stay was 8 days (IQR 3, group 1) and 10 days (IQR 10, group 2) (p = 0.05). The mean follow-up period was 37.6 months (SD = 16.08) with no differences in survival between the groups.

Conclusion

In our setting, the use of a stent and scheduled surgery is safer than IOCL and is associated with lower morbidity, shorter hospital stay, and equally good long-term survival.

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References

  1. Deans GT, Krukowski ZH, Irwin T (1994) Malignant obstruction of the left colon. Br J Surg 81:1270–1276

    Article  PubMed  CAS  Google Scholar 

  2. Serpell JW, McDermott FT, Katrivessis H, Hughes ESR (1989) Obstructing carcinomas of the colon. Br J Surg 76:965–969

    Article  PubMed  CAS  Google Scholar 

  3. Biondo S, Pares D, Frago R et al (2004) Large bowel obstruction: predictive factors for postoperative mortality. Dis Colon Rectum 47:1889–1897

    Article  PubMed  Google Scholar 

  4. Tekkis PP, Kinsman R, Thompson MR, Stamatakis JD (2004) The Association of Coloproctology of Great Britain and Ireland study of large bowel obstruction caused by colorectal cancer. Ann Surg 240:76–81

    Article  PubMed  Google Scholar 

  5. Korenaga D et al (1991) Prognostic factors in Japanese patients with colorectal cancer: the significance of large bowel obstruction univariate and multivariate analyses. J Surg Oncol 47:188–192

    Article  PubMed  CAS  Google Scholar 

  6. Runkel NS et al (1991) Outcome after emergency surgery of the large intestine. Br J Surg 78:183–188

    Article  PubMed  CAS  Google Scholar 

  7. Umpleby HC et al (1984) Survival in acute obstructing colorectal carcinoma. Dis Colon Rectum 27:299–304

    Article  PubMed  CAS  Google Scholar 

  8. Anderson JH, Hole D, McArdle CS (1992) Elective versus emergency surgery for patients with colorectal cancer. Br J Surg 79:706–709

    Article  PubMed  CAS  Google Scholar 

  9. Mitry E, Barthod F, Penna C, Nordlinger B (2002) Surgery for colon and rectal cancer. Best Pract Res Clin Gastroenterol 16:253–265

    Article  PubMed  Google Scholar 

  10. Sprangers MA, Taal BG, Aaronson NK, te Velde A (1995) Quality of life in colorectal cancer. Stoma vs. nonstoma patients. Dis Colon Rectum 38:361–369

    Article  PubMed  CAS  Google Scholar 

  11. Park JJ, Del Pino A, Orsay CP, Nelson RL, Pearl RK, Cintron JR et al (1999) Stoma complications: the Cook County Hospital experience. Dis Colon Rectum 42:1575–1580

    Article  PubMed  CAS  Google Scholar 

  12. Arnaud JP, Tuech JJ, Duplessis R, Pessaux P (1999) Role of subtotal/total colectomy in emergency treatment of occlusive cancer of the left colon. Ann Chir 53:1019–1022

    PubMed  CAS  Google Scholar 

  13. Forloni B et al (1998) Intraoperative colonic lavage in emergency surgical treatment of left-side colonic obstruction. Dis Colon Rectum 41:23–27

    Article  PubMed  CAS  Google Scholar 

  14. Regenet N et al (2003) Primary anastomosis after intraoperative colonic lavage vs. Hartmann’s procedure in generalized peritonitis complicating diverticular disease of the colon. Int J Colorectal Dis 18:503–507

    Article  PubMed  CAS  Google Scholar 

  15. Sjodahl MB, Franzen T, Nystrom PO (1992) Primary versus staged resection for acute obstructing colorectal carcinoma. Br J Surg 79:685–688

    Article  PubMed  CAS  Google Scholar 

  16. Itabashi M, Hamano K, Kameoka S, Asahina K (1993) Self-expanding stainless steel stent application in rectosigmoid stricture. Dis Colon Rectum 36:508–511

    Article  PubMed  CAS  Google Scholar 

  17. Tejero E, Fernandez L, Mainar A, Montes C, Pinto I, Fernandez L, Jorge E, Lozano R (1997) Initial results of a new procedure for the treatment of malignant obstruction of the left colon. Dis Colon Rectum 40:432–436

    Article  PubMed  CAS  Google Scholar 

  18. Khot UP, Wenk Lang A, Murali K, Parker MC (2002) Systematic review of the efficacy and safety of colorectal stents. Br J Surg 89:1096–1102

    Article  PubMed  CAS  Google Scholar 

  19. Suzuki N, Saunders B, Thomas-Gibson S, Akle Ch, Marshall M, Halligan S (2004) Colorectal stenting for malignant and benign disease: outcomes in colorectal stenting. Dis Col Rectum 47:1201–1207

    Article  Google Scholar 

  20. Poon JT, Chan B, Law WL (2005) Evaluation of P-POSSUM in surgery for obstructing colorectal cancer and correlation of the predicted mortality with different surgical options. Dis Colon Rectum 48:493–498

    Article  PubMed  Google Scholar 

  21. Tekkis PP, Prytherch DR, Kocher HM, Senapati A, Poloniecki JD, Stamatakis JD, Windsor AC (2004) Development of a dedicated risk-adjustment scoring system for colorectal surgery (colorectal POSSUM). Br J Surg 91:1174–1182

    Article  PubMed  CAS  Google Scholar 

  22. Fielding LP, Stewart-Brown S, Blesovsky L (1979) Large-bowel obstruction caused by cancer: a prospective study. BMJ 2:515–517

    Article  PubMed  CAS  Google Scholar 

  23. Alcàntara M, Serra X, Bombardó J et al (2007) Colorectal stenting as an effective therapy for preoperative and palliative treatment of large bowel obstruction: 9 years’ experience. Tech Coloproctol 11:316–322

    Article  PubMed  Google Scholar 

  24. Hepworth CC, Thorne L, Langenberg M, Kurucz M, Johnston D (1999) A new safe, simple and swift retrograde method for on-table lavage. Gut 44(suppl 1):TH533 (abstract A134)

    Google Scholar 

  25. Copeland GP, Jones D, Walters M (1991) POSSUM: a scoring system for surgical audit. Br J Surg 78:355–360

    Article  PubMed  CAS  Google Scholar 

  26. Whiteley MS, Prytherch DR, Higgins B, Weaver PC, Prout WG (1996) An evaluation of the POSSUM surgical scoring system. Br J Surg 83:812–815

    Article  PubMed  CAS  Google Scholar 

  27. Compton C, Fenoglio-Preiser CM, Pettigrew N, Fielding LP (2000) American Joint Committee on cancer prognostic factors consensus conference: colorectal working group. Cancer 88:1739–1757

    Article  PubMed  CAS  Google Scholar 

  28. Park IJ, Choi GS, Kang BM, Lim KH, Lee IT, Jeon SW, Jun SH (2009) Comparison of one-stage management of obstructing left-sided colon and rectal cancer: stent-laparoscopic approach vs. intraoperative colonic lavage. J Gastrointest Surg 13:960–965

    Article  PubMed  Google Scholar 

  29. Breitenstein S, Rickenbacher A, Berdajs D, Puhan M, Clavien PA, Demartines N (2007) Systematic evaluation of surgical strategies for acute malignant left-sided colonic obstruction. Br J Surg 94:1451–1460

    Article  PubMed  CAS  Google Scholar 

  30. Finan PJ, Campbell S, Verma R, MacFie J, Gatt M, Parker MC, Bhardwaj R, Hall NR (2007) The management of malignant large bowel obstruction: ACPGBI position statement. Colorectal Dis 9(Suppl 4):1–17

    Article  PubMed  Google Scholar 

  31. Stamatakis J, Thompson M, Chave H et al (2000) National audit of bowel obstruction due to colorectal cancer April 1998-March 1999: The Association of Coloproctology of Great Britain and Ireland. London: ACPGBI. www.acpgbi.org.uk

  32. Borowski DW, Kelly SB, Bradburn DM, Wilson RG, Gunn A, Ratcliffe AA, Northern Region Colorectal Cancer Audit Group (2007) Impact of surgeon volume and specialization on short-term outcomes in colorectal cancer surgery. Br J Surg 94:880–889

    Article  PubMed  CAS  Google Scholar 

  33. Biondo S, Jaurrieta E, Jorba R, Moreno P, Farran L, Borobia F, Bettonica C, Poves I, Ramos E, Alcobendas F (1997) Intraoperative colonic lavage and primary anastomosis in peritonitis and obstruction. Br J Surg 84:222–225

    Article  PubMed  CAS  Google Scholar 

  34. Bromage SJ, Cunliffe WJ (2007) Validation of the CR-POSSUM risk-adjusted scoring system for major colorectal cancer surgery in a single center. Dis Colon Rectum 50:192–196

    Article  PubMed  Google Scholar 

  35. Osman HS, Rashid HI, Sathananthan N, Parker MC (2000) The cost effectiveness of self-expanding metal stents in the management of malignant left sided large bowel obstruction. Colorectal Dis 2:233–237

    Article  Google Scholar 

  36. Targownik LE, Spiegel BM, Sack J, Hines OJ, Dulai GS, Gralnek IM, Farrell JJ (2004) Colonic stent vs. emergency surgery for management of acute left-sided malignant colonic obstruction: a decision analysis. Gastrointest Endosc 60:865–874

    Article  PubMed  Google Scholar 

  37. Tilney HS, Lovegrove RE, Purkayastha S, Sains PS, Weston-Petrides GK, Darzi AW, Tekkis PP, Heriot AG (2007) Comparison of colonic stenting and open surgery for malignant large bowel obstruction. Surg Endosc 21:225–233

    Article  PubMed  CAS  Google Scholar 

  38. Dastur JK, Forshaw MJ, Modarai B, Solkar MM, Raymond T, Parker MC (2008) Comparison of short- and long-term outcomes following either insertion of self-expanding metallic stents or emergency surgery in malignant large bowel obstruction. Tech Coloproctol 12:51–55

    Article  PubMed  CAS  Google Scholar 

  39. Lim JF, Tang CL, Seow-Choen F, Heah SM (2005) Prospective, randomized trial comparing intraoperative colonic irrigation with manual decompression only for obstructed left-sided colorectal cancer. Dis Colon Rectum 48:205–209

    Article  PubMed  CAS  Google Scholar 

  40. The SCOTIA Study Group (1995) Single-stage treatment for malignant left-sided colonic obstruction: a prospective randomized clinical trial comparing subtotal colectomy with segmental resection following intraoperative irrigation. Br J Surg 82:1622–1627

    Article  Google Scholar 

  41. Hennekinne-Mucci S, Tuech JJ, Brehant O, Lermite E, Bergamaschi R, Pessaux P et al (2006) Emergency subtotal/total colectomy in the management of obstructed left colon carcinoma. Int J Colorectal Dis 21:538–541

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

The author would like to thank Dr. Pere Rebasa for the help in statistical analysis. This study received a grant from the Parc Taulí Foundation in 2003. The registration number is NCT01196494 at htpp://clinicaltrials.gov.

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Authors and Affiliations

  1. Colorectal Surgery Unit, Corporación Sanitaria y Universitaria Parc Tauli (Universitat Autónoma de Barcelona), Parc Taulí s/n, 08208, Sabadell, Barcelona, Spain

    M. Alcántara, X. Serra-Aracil, L. Mora, J. Bombardó & S. Navarro

  2. Radiodiagnosis Service (UDIAT), Corporación Sanitaria y Universitaria Parc Tauli (Universitat Autonoma de Barcelona), Sabadell, Spain

    J. Falcó

Authors
  1. M. Alcántara
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  2. X. Serra-Aracil
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  3. J. Falcó
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  4. L. Mora
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  5. J. Bombardó
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  6. S. Navarro
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Correspondence to M. Alcántara.

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Alcántara, M., Serra-Aracil, X., Falcó, J. et al. Prospective, Controlled, Randomized Study of Intraoperative Colonic Lavage Versus Stent Placement in Obstructive Left-sided Colonic Cancer. World J Surg 35, 1904–1910 (2011). https://doi.org/10.1007/s00268-011-1139-y

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