Curative resection for left colonic carcinoma: Hemicolectomy vs. Segmental colectomy

A prospective, controlled, multicenter trial

Abstract

PURPOSE: This study was developed to compare median and actuarial survival after left hemicolectomyvs.left segmental colectomy. METHODS: Between January 1980 and January 1985, 270 consecutive patients (133 males and 137 females; mean age, 64±12 (range, 18–91) years with left colonic carcinoma located between the left third of the transverse colon and (but not, including) the colorectal juncture were randomly allotted to undergo either left hemicolectomy or left segmental colectomy. Left hemicolectomy removed the entire left colon along with the origin of the inferior mesenteric artery and the dependent lymphatic territory. Left segmentai colectomy removed a more restricted segment of the colon and left the origin of the inferior mesenteric artery unmolested. RESULTS: After elimination of 10 patients for protocol violation, 131 patients with left hemicolectomy and 129 with left segmental colectomy were analyzed. Both groups were similar with regard to preoperative risk factors (age, sex, obesity, weight loss, anemia, diabetes, cirrhosis, kidney failure, steroid therapy or radiation therapy performed for any cause other than cancer), pathology findings (size, degree of differentiation, Dukes stage, invasion of lymph nodes at the origin of the inferior mesenteric artery), and associated lesions. Only the length of tumor-free margins of colon removed was significantly longer in left hemicolectomy. The number of early postoperative abdominal and extra-abdominal complications was similar in both groups. Overall, early postoperative mortality was 4 percent higher, but not significantly in left hemicolectomy (eight deaths, 6 percent) than in left segmental colectomy (three deaths, 2 percent). Median survival was 10 years and nearly equivalent in both groups. The two actuarial survivai curves were similar. Bowel movement frequency was significantly increased after left hemicolectomy during the first postoperative year. Our results suggest that survival after left segmental colectomy is equivalent to that of left hemicolectomy. Notwithstanding the observation of other carcinologic rules, left segmental colectomy rather than left hemicolectomy may theoretically be performed under laparoscopy without compromising the carcinologic outcome.

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References

  1. 1.

    McArdle CS, Hole D, Hansell D, Wood CB. Prospective study of colorectal cancer in the West Scotland: 10-year follow-up. Br J Surg 1990;77:280–2.

    PubMed  CAS  Google Scholar 

  2. 2.

    Deans GT, Parks TG, Rowlands BJ, Spence RA. Prognostic factors in colorectal cancer. Br J Surg 1992;79:608–13.

    PubMed  CAS  Google Scholar 

  3. 3.

    Evans JT, Vana J, Aronoff BL, Baker HW, Murphy GP. Management and survival of carcinoma of the colon: results of a national survey by the American College of Surgeons. Ann Surg 1978;168:716–20.

    Google Scholar 

  4. 4.

    Sugarbaker PH, Corlew S. Influence of surgical techniques on survival in patients with colorectal cancer. Dis Colon Rectum 1982;25:545–57.

    PubMed  CAS  Google Scholar 

  5. 5.

    Busuttil RW, Foglia RP, Longmire WP. Treatment of carcinoma of the sigmoid colon and upper rectum. A comparison of local segmental resection and left hemicolectomy. Arch Surg 1977;112:920–3.

    PubMed  CAS  Google Scholar 

  6. 6.

    Jeekel J. Curative resection of primary colorectal cancer. Br J Surg 1986;73:687–8.

    PubMed  CAS  Google Scholar 

  7. 7.

    Ault GW. A technique for cancer isolation and extended dissection for cancer of the distal colon and rectum. Surg Gynecol Obstet 1958;106:467–77.

    PubMed  CAS  Google Scholar 

  8. 8.

    Bacon EH, McGregor JK. Prevention of recurrent carcinoma of the colon and rectum: report on 236 patients. Dis Colon Rectum 1963;6:209–14.

    PubMed  CAS  Google Scholar 

  9. 9.

    Dwight RW, Higgins GA, Keehn RJ. Factors influencing survival after resection in cancer of the colon and rectum. Am J Surg 1969;117:513–22.

    Google Scholar 

  10. 10.

    Enker WE, Laffer V, Block GE. Enhanced survival of patients with colon and rectal cancer is based upon wide anatomic resection. Ann Surg 1979;190:350–60.

    PubMed  CAS  Google Scholar 

  11. 11.

    Grinnel RS. Results of ligation of inferior mesenteric artery at the aorta in resection of carcinoma of the descending and sigmoid colon and rectum. Surg Gynecol Obstet 1965;120:1031–6.

    Google Scholar 

  12. 12.

    McElwain JW, Bacon HE, Trimpi HD. Lymph node metastases: experience with aortic ligation of inferior mesenteric artery in cancer of the rectum. Surgery 1954;35:513–31.

    PubMed  CAS  Google Scholar 

  13. 13.

    Moynihan BG. The survival treatment of cancer of the sigmoid flexure and rectum. Surg Gynecol Obstet 1908;6:463–6.

    Google Scholar 

  14. 14.

    Polk HC Jr. Extended resection for selected adenocarcinoma of the large bowel. Ann Surg 1972;175:892–9.

    PubMed  Google Scholar 

  15. 15.

    Rosi PA, Cahill WJ, Carey J. A ten-year study of hemicolectomy in the treatment of carcinoma of the left half of the colon. Surg Gynecol Obstet 1962;114:15–24.

    PubMed  CAS  Google Scholar 

  16. 16.

    Surtees P, Ritchie JK, Phillips RK. High versus low ligation of the inferior mesenteric artery in rectal cancer. Br J Surg 1990;77:618–21.

    PubMed  CAS  Google Scholar 

  17. 17.

    Gabriel WB, Dukes C, Bussey HJ. Lymphatic spread in cancer of the rectum. Br J Surg 1935;23:395–413.

    Google Scholar 

  18. 18.

    Harvey HD, Auchincloss H. Metastases to lymph nodes from carcinomas that were arrested. Cancer 1968;21:684–91.

    PubMed  CAS  Google Scholar 

  19. 19.

    Morgan CN. The comparative results and treatment for cancer of the rectum. Postgrad Med 1959;26:135–41.

    PubMed  CAS  Google Scholar 

  20. 20.

    Griffen JR. Is segmental sounder? Dis Colon Rectum 1982;25:340–2.

    PubMed  Google Scholar 

  21. 21.

    Moertel CG, Fleming TR, Macdonald JS,et al. Levamisole and fluorouracil for adjuvant therapy of resected colon carcinoma. N Engl J Med 1990;322:352–8.

    PubMed  CAS  Article  Google Scholar 

  22. 22.

    Lorentz FH. Ein neuer Konstitutionsindex. Klin Wochenshr 1929;8:348–51.

    Google Scholar 

  23. 23.

    Rodary M, Hay JM, Fingerhut A, Oberlin P. French Association for Surgical Research. Conventional mechanical preparation versus whole-gut irrigation for elective colonic resection: a multicentric prospective controlled trial. Coloproctology 1987;9:87–93.

    Google Scholar 

  24. 24.

    French Association for Surgical Research: Rodary M, Fingerhut A, Hay JM. Mechanical and antibiotic preparation of the bowel for elective colorectal surgery. Three-day versus one-day preparation. Coloproctology 1988;5: 2:71–6.

    Google Scholar 

  25. 25.

    Turnbull RB Jr, Kyle K, Watson R, Spratt J. Cancer of the colon: the influence of the no touch isolation technique on survival rates. Ann Surg 1967;166:420–7.

    PubMed  Article  Google Scholar 

  26. 26.

    Minton JP, Hoehn JL, Gerber DM,et al. Results of a 400 patient carcinoembryonic antigen second-look colorectal cancer study. Cancer 1985;55:1284–90.

    PubMed  CAS  Google Scholar 

  27. 27.

    Cole WH, Roberts SS, Strehl FW. Modern concepts in cancer of the colon and rectum. Cancer 1966;19:1347–58.

    PubMed  CAS  Google Scholar 

  28. 28.

    Miller DR, Allhutten FF Jr. Carcinoma of the colon and rectum. Arch Surg 1976;111:692–6.

    PubMed  CAS  Google Scholar 

  29. 29.

    Dukes CE. The classification of cancer of the rectum. J Pathol Bacteriol 1932;35:322–32.

    Google Scholar 

  30. 30.

    Schwartz D, Flamant R, Lellouch J. Clinical trials. London: Academic Press, 1980.

    Google Scholar 

  31. 31.

    Murray GD. Statistical aspects of research methodology. Br J Surg 1991;78:777–81.

    PubMed  CAS  Google Scholar 

  32. 32.

    Cancer Research Campaign Working Party. Trials and tribulations: thoughts on the organization of multicentre clinical studies. BMJ 1980;281:918–20.

    Article  Google Scholar 

  33. 33.

    Chapuis PH, Dent OF, Newland RC, Bokey LL, Pheils MT. An evaluation of the American Joint Committee (PTMN) staging method for cancer of the colon and rectum. Dis Colon Rectum 1986;29:6–10.

    PubMed  CAS  Google Scholar 

  34. 34.

    Pezim ME, Nicholls RJ. Survival after high or low ligation of the inferior mesenteric artery during curative surgery of rectal cancer. Ann Surg 1984;200:729–33.

    PubMed  CAS  Google Scholar 

  35. 35.

    Black WA, Waugh J. The intramural extension of carcinoma of the descending colon, sigmoid, and rectosigmoid: a pathologic study. Surg Gynecol Obstet 1948;87:457–64.

    PubMed  CAS  Google Scholar 

  36. 36.

    Goligher JC, Dukes CE, Bussey HJ. Local recurrences after sphincter-saving excisions for carcinoma of the rectum and rectosigmoid. Br J Surg 1951;39:199–211.

    PubMed  CAS  Google Scholar 

  37. 37.

    Phillips EH, Franklin M, Carroll BJ, Fallas MJ, Ramos R, Rosenthal D. Laparoscopic colectomy. Ann Surg 1992;216:703–7.

    PubMed  CAS  Google Scholar 

  38. 38.

    Cooperman M, Martin EW, Carey LC. Evaluation of ischemic intestine by Doppler Ultrasound. Am J Surg 1980;139:73–7.

    PubMed  CAS  Google Scholar 

Download references

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Correspondence to Jean-Marie Hay M.D..

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The French Association for Surgical Research., Rouffet, F., Hay, JM. et al. Curative resection for left colonic carcinoma: Hemicolectomy vs. Segmental colectomy. Dis Colon Rectum 37, 651–659 (1994). https://doi.org/10.1007/BF02054407

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Key words

  • Carcinoma
  • Colonic
  • Sigmoid colorectal carcinoma
  • Colonic resection
  • Segmental resection
  • Lymphatic
  • Wide lymphadenectomy
  • Prospective randomized trial
  • Follow-up
  • Laparoscopic colectomy