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Right-sided vs. left-sided obstructing colonic cancer: results of a multicenter study of the French Surgical Association in 2325 patients and literature review

  • Diane Mege
  • Gilles Manceau
  • Laura Beyer
  • Valérie Bridoux
  • Zaher Lakkis
  • Aurélien Venara
  • Thibault Voron
  • Nicolas de’Angelis
  • Solafah Abdalla
  • Igor Sielezneff
  • Mehdi KarouiEmail author
  • On behalf of the AFC (French Surgical Association) Working Group
Original Article
  • 62 Downloads

Abstract

Purpose

Few studies compared management and outcomes of obstructing colonic cancer (OCC), according to the tumor site. Our aim was to compare patient and tumor characteristics, postoperative and pathological results, and oncological outcomes after emergency management of right-sided vs. left-sided OCC.

Methods

A national cohort study including all consecutive patients managed for OCC from 2000 to 2015 in French surgical centers members of the French National Surgical Association (AFC).

Results

During the study period, 2325 patients with OCC were divided in right-sided (n = 819, 35%) and left-sided (n = 1506, 65%) locations. Patients with right-sided OCC were older, more frequently females, and associated with comorbidities, history of cancer, or previous laparotomy. Surgical management was more frequently performed for right-sided than left-sided OCC (99 vs. 96%, p < 0.0001). Tumor resection was more frequently performed in right-sided OCC (95 vs. 90%, p < 0.0001). Among the resected patients, primary anastomosis was more frequently performed in case of right-sided OCC (86 vs. 62%, p < 0.0001). Definitive stoma rate was lower in right-sided location (17 vs. 46%, p < 0.0001). There was no significant difference between locations in terms of cumulative morbidity, anastomotic leak, unplanned reoperation, and mortality. Five-year overall and disease-free survival rates were significantly lower in right-sided OCC (43 and 36%) than in left-sided OCC (53 and 46%, p < 0.0001 and p = 0.001, respectively).

Conclusions

Although patients with right-sided OCC are frailer than left-sided OCC, tumor resection and anastomosis are more frequently performed, without difference in surgical results. However, right-sided OCC is associated with worse prognosis than distal location.

Keywords

Colonic obstruction Right-sided obstructing colon cancer Left-sided obstructing colon cancer Survival Emergency surgery National database 

Notes

Acknowledgements

Collaborator list of the AFC working group: Mehdi Ouaissi, Charles Sabbagh, Jean-Marc Regimbeau, Tatiana Codjia, Marie Dazza, Guillaume Gagnat, Servane Hamel, Laure Mallet, Paul Martre, Guillaume Philouze, Edouard Roussel, Pauline Tortajada, Anne Stéphanie Dumaine, Bruno Heyd, Brice Paquette, Nicolas De Angelis, Franscesco Brunetti, Francesco Esposito, Vincenzo Lizzi, Nicolas Michot, Quentin Denost, Christophe Tresallet, Oriana Tetard, Pauline Rivier, Elie Fayssal, Maxime Collard, David Moszkowicz, Frederique Peschaud, Jean Charles Etienne, Ludovic loge, Thierry Bege, Hélène Corte, Elsa D’Annunzio, Marine Humeau, Julien Issard, Nicolas Munoz, Julio Abba, Yaqoub Jafar, Laurence Lacaze, Pierre-Yves Sage, Lilija Susoko, Bertrand Trilling, Catherine Arvieux, François Mauvais, Béatrice Ulloa-Severino, Sophie Pitel, Arthus Vauchaussade de Chaumont, Bogdan Badic, Benjamin Blanc, Marine Bert, Paul Rat, Pablo Ortega-Deballon, Amélie Chau, Clémentine Dejeante, Guillaume Piessen, Emilie Grégoire, Abdallah Alfarai, Jérémie H Lefèvre, Magali Cabau, Anaelle David, Deborah Kadoche, Fanny Dufour, Géraldine Goin, Yvain Goudard, Ghislain Pauleau, Philippe Sockeel, Bruno De la Villeon, Karine Pautrat, Clarisse Eveno, Antoine Brouquet, Anne Cécile Couchard, Gregoire Balbo, Jean Yves Mabrut, Justine Bellinger, Martin Bertrand, Aurélie Aumont, Emilie Duchalais, Anne-Sophie Messière Adrien Tranchart, Jean-Baptiste Cazauran, Virginie Pichot-Delahaye, Vincent Dubuisson, Leon Maggiori, Bilem Djawad Boumediene, David Fuks, Xavier Kahn, Eve Huart, Jean-Marc Catheline, Grégory Lailler, Oussama Baraket, Patrick Baque, Jean Marie Diaz de Cerio, Philippe Mariol Bernard Maes, Philippe Fernoux, Philippe Guillem, Eric Chatelain, Charlotte de Saint Roman, Kévin Fixot.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A (2015) Global cancer statistics, 2012. CA Cancer J Clin 65:87–108.  https://doi.org/10.3322/caac.21262 CrossRefGoogle Scholar
  2. 2.
    McArdle CS, McMillan DC, Hole DJ (2006) The impact of blood loss, obstruction and perforation on survival in patients undergoing curative resection for colon cancer. Br J Surg 93:483–488.  https://doi.org/10.1002/bjs.5269 CrossRefGoogle Scholar
  3. 3.
    Tan E, Tilney H, Thompson M, Smith J, Tekkis PP, Association of Coloproctology of Great Britain and Ireland (2007) The United Kingdom National Bowel Cancer Project—epidemiology and surgical risk in the elderly. Eur J Cancer 43:2285–2294.  https://doi.org/10.1016/j.ejca.2007.06.009 CrossRefGoogle Scholar
  4. 4.
    Jiang JK, Lan YT, Lin TC, Chen WS, Yang SH, Wang HS, Chang SC, Lin JK (2008) Primary vs. delayed resection for obstructive left-sided colorectal cancer: impact of surgery on patient outcome. Dis Colon Rectum 51:306–311.  https://doi.org/10.1007/s10350-007-9173-4 CrossRefGoogle Scholar
  5. 5.
    Aslar AK, Ozdemir S, Mahmoudi H, Kuzu MA (2011) Analysis of 230 cases of emergent surgery for obstructing colon cancer—lessons learned. J Gastrointest Surg 15:110–119.  https://doi.org/10.1007/s11605-010-1360-2 CrossRefGoogle Scholar
  6. 6.
    Cortet M, Grimault A, Cheynel N, Lepage C, Bouvier AM, Faivre J (2013) Patterns of recurrence of obstructing colon cancers after surgery for cure: a population-based study. Color Dis 15:1100–1116.  https://doi.org/10.1111/codi.12268 Google Scholar
  7. 7.
    Mege D, Manceau G, Beyer-Berjot L, Bridoux V, Lakkis Z, Venara A, Voron T, Brunetti F, Sielezneff I, Karoui M, Berger A, Ouaissi M, Codjia T, Dazza M, Gagnat G, Hamel S, Mallet L, Martre P, Philouze G, Roussel E, Tortajada P, Dumaine AS, Heyd B, Lakkis Z, Paquette B, de' Angelis N, Esposito F, Lizzi V, Michot N, Denost Q, Tresallet C, Tetard O, Sabbagh C, Rivier P, Fayssal E, Collard M, Moszkowicz D, Peschaud F, Etienne JC, loge L, Beyer-Berjot L, Bege T, Corte H, Bonnet J, D'Annunzio E, Humeau M, Issard J, Munoz N, Abba J, Jafar Y, Lacaze L, Sage PY, Susoko L, Trilling B, Arvieux C, Mauvais F, Severino BU, Pitel S, Vauchaussade de Chaumont A, Badic B, Blanc B, Bert M, Rat P, Ortega-Deballon P, Chau A, Dejeante C, Mariette C, Piessen G, Grégoire E, Alfarai A, Lefèvre J, Cabau M, David A, Kadoche D, Dufour F, Goin G, Goudard Y, Pauleau G, Sockeel P, de la Villeon B, Pautrat K, Eveno C, Brouquet A, Couchard AC, Balbo G, Mabrut JY, Bellinger J, Bertrand M, Aumont A, Duchalais E, Messière Adrien Tranchart AS, Cazauran JB, Pichot-Delahaye V, Dubuisson V, Maggiori L, Boumediene BD, Fuks D, Kahn X, Huart E, Catheline JM, Lailler G, Baraket O, Baque P, Diaz de Cerio JM, Bernard Maes PM, Fernoux P, Guillem P, Chatelain E, de Saint Roman C, Fixot K (2018) Surgical management of obstructive right-sided colon cancer at a national level results of a multicenter study of the French Surgical Association in 776 patients. Eur J Surg Oncol 44:1522–1531.  https://doi.org/10.1016/j.ejso.2018.06.027 CrossRefGoogle Scholar
  8. 8.
    Ng SSM, Lee JFY, Yiu RYC, Li JCM, Leung WW, Leung KL (2008) Emergency laparoscopic-assisted versus open right hemicolectomy for obstructing right-sided colonic carcinoma: a comparative study of short-term clinical outcomes. World J Surg 32:454–458.  https://doi.org/10.1007/s00268-007-9400-0 CrossRefGoogle Scholar
  9. 9.
    Amelung FJ, Consten ECJ, Siersema PD, Tanis PJ (2016) A population-based analysis of three treatment modalities for malignant obstruction of the proximal Colon: acute resection versus stent or stoma as a bridge to surgery. Ann Surg Oncol 23:3660–3668.  https://doi.org/10.1245/s10434-016-5247-7 CrossRefGoogle Scholar
  10. 10.
    Kronborg O (1995) Acute obstruction from tumour in the left colon without spread. A randomized trial of emergency colostomy versus resection. Int J Color Dis 10:1–5CrossRefGoogle Scholar
  11. 11.
    The SCOTIA Study Group. Subtotal Colectomy versus On-table Irrigation and Anastomosis (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 82:1622–1627Google Scholar
  12. 12.
    Ansaloni L, Andersson RE, Bazzoli F, Catena F, Cennamo V, di Saverio S, Fuccio L, Jeekel H, Leppäniemi A, Moore E, Pinna AD, Pisano M, Repici A, Sugarbaker PH, Tuech JJ (2010) 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 WJES 5:29.  https://doi.org/10.1186/1749-7922-5-29 CrossRefGoogle Scholar
  13. 13.
    Mege D, Sabbagh C, Manceau G et al (2019) What is the best option between primary diverting stoma or endoscopic stent as a bridge to surgery with a curative intent for obstructed left colon cancer? Results from a propensity score analysis of the French Surgical Association multicenter cohort of 518 patients. Ann Surg Oncol 26:756–764.  https://doi.org/10.1245/s10434-018-07139-0 CrossRefGoogle Scholar
  14. 14.
    Mege D, Manceau G, Guedj N, Maggiori L, Panis Y (2019) Surgical management of obstructive left colon cancer at a national level: results of a multicentre study of the French Surgical Association in 1500 patients. J Visc Surg 153:247–251.  https://doi.org/10.1016/j.jchirv.2016.03.004 Google Scholar
  15. 15.
    Lee YM, Law WL, Chu KW, Poon RT (2001) Emergency surgery for obstructing colorectal cancers: a comparison between right-sided and left-sided lesions. J Am Coll Surg 192:719–725CrossRefGoogle Scholar
  16. 16.
    Hsu T-C (2005) Comparison of one-stage resection and anastomosis of acute complete obstruction of left and right colon. Am J Surg 189:384–387.  https://doi.org/10.1016/j.amjsurg.2004.06.046 CrossRefGoogle Scholar
  17. 17.
    Tan K-K, Sim R (2010) Surgery for obstructed colorectal malignancy in an Asian population: predictors of morbidity and comparison between left- and right-sided cancers. J Gastrointest Surg 14:295–302.  https://doi.org/10.1007/s11605-009-1074-5 CrossRefGoogle Scholar
  18. 18.
    Frago R, Biondo S, Millan M, Kreisler E, Golda T, Fraccalvieri D, Miguel B, Jaurrieta E (2011) Differences between proximal and distal obstructing colonic cancer after curative surgery. Color Dis 13:e116–e122.  https://doi.org/10.1111/j.1463-1318.2010.02549.x CrossRefGoogle Scholar
  19. 19.
    Faucheron J-L, Paquette B, Trilling B, Heyd B, Koch S, Mantion G (2018) Emergency surgery for obstructing colonic cancer: a comparison between right-sided and left-sided lesions. Eur J Trauma Emerg Surg 44:71–77.  https://doi.org/10.1007/s00068-017-0766-x CrossRefGoogle Scholar
  20. 20.
    Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefGoogle Scholar
  21. 21.
    von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet (London, England) 370:1453–1457.  https://doi.org/10.1016/S0140-6736(07)61602-X CrossRefGoogle Scholar
  22. 22.
    Benedix F, Kube R, Meyer F, Schmidt U, Gastinger I, Lippert H, Colon/Rectum Carcinomas (Primary Tumor) Study Group (2010) Comparison of 17,641 patients with right- and left-sided colon cancer: differences in epidemiology, perioperative course, histology, and survival. Dis Colon Rectum 53:57–64.  https://doi.org/10.1007/DCR.0b013e3181c703a4 CrossRefGoogle Scholar
  23. 23.
    Benedix F, Schmidt U, Mroczkowski P, Gastinger I, Lippert H, Kube R, Study Group “Colon/Rectum Carcinoma (Primary Tumor)” (2011) Colon carcinoma—classification into right and left sided cancer or according to colonic subsite?—Analysis of 29,568 patients. Eur J Surg Oncol 37:134–139.  https://doi.org/10.1016/j.ejso.2010.12.004 CrossRefGoogle Scholar
  24. 24.
    Aoyama T, Kashiwabara K, Oba K, Honda M, Sadahiro S, Hamada C, Maeda H, Mayanagi S, Kanda M, Sakamoto J, Saji S, Yoshikawa T (2017) Clinical impact of tumor location on the colon cancer survival and recurrence: analyses of pooled data from three large phase III randomized clinical trials. Cancer Med 6:2523–2530.  https://doi.org/10.1002/cam4.1208 CrossRefGoogle Scholar
  25. 25.
    Tiret E (1998) Emergency management for colonic cancer. Gastroentérol Clin Biol 22:S102–S107Google Scholar
  26. 26.
    van Hooft JE, van Halsema EE, Vanbiervliet G, Beets-Tan RG, DeWitt J, Donnellan F, Dumonceau JM, Glynne-Jones RG, Hassan C, Jiménez-Perez J, Meisner S, Muthusamy VR, Parker MC, Regimbeau JM, Sabbagh C, Sagar J, Tanis PJ, Vandervoort J, Webster GJ, Manes G, Barthet MA, Repici A, European Society of Gastrointestinal Endoscopy (ESGE) (2014) Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Gastrointest Endosc 80:747–761.e1–75.  https://doi.org/10.1016/j.gie.2014.09.018 CrossRefGoogle Scholar
  27. 27.
    Endoscopy and Cancer Committee of the French Society of Digestive Endoscopy (SFED) and the French Federation of Digestive Oncology (FFCD) (2014) Place of colorectal stents in therapeutic management of malignant large bowel obstructions. Endoscopy 46:546–552.  https://doi.org/10.1055/s-0034-1365307 CrossRefGoogle Scholar
  28. 28.
    Chin C-C, Wang J-Y, Changchien C-R, Huang WS, Tang R (2010) Carcinoma obstruction of the proximal colon cancer and long-term prognosis—obstruction is a predictor of worse outcome in TNM stage II tumor. Int J Color Dis 25:817–822.  https://doi.org/10.1007/s00384-010-0904-y CrossRefGoogle Scholar
  29. 29.
    Auclin E, Zaanan A, Vernerey D, Douard R, Gallois C, Laurent-Puig P, Bonnetain F, Taieb J (2017) Subgroups and prognostication in stage III colon cancer: future perspectives for adjuvant therapy. Ann Oncol 28:958–968.  https://doi.org/10.1093/annonc/mdx030 Google Scholar
  30. 30.
    He X, Wu W, Ding Y et al (2018) Different anatomical subsites of colon cancer and mortality: a population-based study. Gastroenterol Res Pract 2018:1–9.  https://doi.org/10.1155/2018/7153685 Google Scholar
  31. 31.
    Mendis S, Beck S, Lee B, Lee M, Wong R, Kosmider S, Shapiro J, Yip D, Steel S, Nott L, Jennens R, Lipton L, Burge M, Field K, Ananda S, Wong HL, Gibbs P (2019) Right versus left sided metastatic colorectal cancer: teasing out clinicopathologic drivers of disparity in survival. Asia Pac J Clin Oncol.  https://doi.org/10.1111/ajco.13135
  32. 32.
    Yahagi M, Okabayashi K, Hasegawa H, Tsuruta M, Kitagawa Y (2016) The worse prognosis of right-sided compared with left-sided Colon cancers: a systematic review and meta-analysis. J Gastrointest Surg 20:648–655.  https://doi.org/10.1007/s11605-015-3026-6 CrossRefGoogle Scholar
  33. 33.
    Weiss JM, Pfau PR, O’Connor ES et al (2011) Mortality by stage for right- versus left-sided colon cancer: analysis of surveillance, epidemiology, and end results—Medicare data. J Clin Oncol 29:4401–4409.  https://doi.org/10.1200/JCO.2011.36.4414 CrossRefGoogle Scholar
  34. 34.
    Weiss JM, Schumacher J, Allen GO, Neuman H, Lange EO’C, LoConte NK, Greenberg CC, Smith MA (2014) Adjuvant chemotherapy for stage II right-sided and left-sided colon cancer: analysis of SEER-Medicare data. Ann Surg Oncol 21:1781–1791.  https://doi.org/10.1245/s10434-014-3631-8 CrossRefGoogle Scholar
  35. 35.
    Foxtrot Collaborative Group (2012) Feasibility of preoperative chemotherapy for locally advanced, operable colon cancer: the pilot phase of a randomised controlled trial. Lancet Oncol 13:1152–1160.  https://doi.org/10.1016/S1470-2045(12)70348-0 CrossRefGoogle Scholar
  36. 36.
    Karoui M, Rullier A, Luciani A, Bonnetain F, Auriault ML, Sarran A, Monges G, Trillaud H, le Malicot K, Leroy K, Sobhani I, Bardier A, Moreau M, Brindel I, Seitz JF, Taieb J (2015) Neoadjuvant FOLFOX 4 versus FOLFOX 4 with Cetuximab versus immediate surgery for high-risk stage II and III colon cancers: a multicentre randomised controlled phase II trial—the PRODIGE 22-ECKINOXE trial. BMC Cancer 15:511.  https://doi.org/10.1186/s12885-015-1507-3 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Diane Mege
    • 1
  • Gilles Manceau
    • 2
  • Laura Beyer
    • 3
  • Valérie Bridoux
    • 4
  • Zaher Lakkis
    • 5
  • Aurélien Venara
    • 6
  • Thibault Voron
    • 7
  • Nicolas de’Angelis
    • 8
  • Solafah Abdalla
    • 9
  • Igor Sielezneff
    • 1
  • Mehdi Karoui
    • 2
    Email author
  • On behalf of the AFC (French Surgical Association) Working Group
  1. 1.Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille, Department of Digestive SurgeryTimone University HospitalMarseilleFrance
  2. 2.Sorbonne Université, Assistance Publique Hôpitaux de Paris, Department of Digestive and Hepatopancreato-Biliary SurgeryPitié Salpêtrière University HospitalParis Cedex 13France
  3. 3.North University HospitalMarseilleFrance
  4. 4.Charles Nicolle University HospitalRouenFrance
  5. 5.Besançon University HospitalBesanconFrance
  6. 6.Angers University HospitalAngersFrance
  7. 7.Saint Antoine University HospitalSorbonne UniversityParisFrance
  8. 8.Henri Mondor University HospitalUniversité Paris-ESTCreteilFrance
  9. 9.Bicêtre University HospitalUniversité Paris–SudLe Kremlin BicetreFrance

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