Skip to main content

Advertisement

SpringerLink
Log in

Efficacy of loop colostomy construction for acute left-sided colonic obstructions: a cohort analysis

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Acute primary resection as treatment for left-sided colonic obstruction (LSCO) is notorious for its high morbidity and mortality rates. Both stenting and loop colostomy construction can serve as a bridge to surgery, hereby avoiding the high morbidity and mortality rates associated with emergency resections. This study aims to investigate the safety of a loop colostomy in patients presenting with acute LSCO.

Methods

Retrospective analysis of all patients that received a loop colostomy for LSCO between 2003 and 2015 was performed. Primary outcomes were mortality, major morbidity (Clavien-Dindo grades III–IV) and minor morbidity (Clavien-Dindo grades I–II).

Results

One hundred forty-six patients presenting with acute LSCO received a diverting colostomy. After colostomy construction, mortality occurred in four patients (2.7%) and major complications were reported in 20 patients (13.7%). In 61 patients, the diverting colostomy served as a palliative measure, because of metastatic disease or unfitness for major surgery. The remaining 85 patients all underwent delayed resection, resulting in an overall mortality, major morbidity and minor morbidity of 6.9% (n = 6), 14.0% (n = 12) and 26.7% (n = 23), respectively.

Conclusions

Diverting colostomy construction is a minimally invasive and safe treatment option for LSCO. It can serve as a definite palliative measure, as well as a bridge to elective surgery. A diverting colostomy as a bridge to surgery might even be a valid alternative for emergency resections, since mortality and morbidity rates following colostomy construction and delayed resection appear lower than reported outcomes following primary resection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Dutch cancer registration. http://www.cijfersoverkanker.nl/selecties/Dataset_1/img54e494ab18fdf. Accessed September 7th, 2015.

  2. Jullumstro E, Wibe A, Lydersen S, Adna TH (2011) Colon cancer incidence, presentation, treatment and outcomes over 25 years. Color Dis 13:512–518

    Article  CAS  Google Scholar 

  3. Winner M, Mooney SJ, Hershman DL, Hershman DL, Feingold DL, Allendorf JD, Wright JD, Neugut AI (2013) Incidence and predictors of bowel obstruction in elderly patients with stage IV colon cancer: a population-based cohort study. J Am Med Assoc Surg 148:715–722

    Google Scholar 

  4. Scott NA, Jeacock J, Kingston RD (1995) Risk factors in patients presenting as an emergency with colorectal cancer. Br J Surg 82(3):321–323

    Article  CAS  PubMed  Google Scholar 

  5. Hennessey DB, Burke JP, Ni-Dhonochu T, Shields C, Winter DC, Mealy K (2010) Preoperative hypoalbuminemia is an independent risk factor for the development of surgical site infection following gastrointestinal surgery: a multi-institutional study. Ann Surg 252(2):325–329

    Article  PubMed  Google Scholar 

  6. Smothers L, Hynan L, Fleming J, Turnage R, Simmang C, Anthony T (2003) Emergency surgery for colon carcinoma. Dis Colon rectum 46(1):24–30

    Article  PubMed  Google Scholar 

  7. Huang X, Lv B, Zhang S, Meng L (2014) Preoperative colonic stents versus emergency surgery for acute left-sided malignant colonic obstruction: a meta-analysis. J Gastrointest Surg 18(3):584–591

    Article  PubMed  Google Scholar 

  8. Tanis PJ, Paulino Pereira NR, van Hooft JE, Consten ECJ, Bemelman WA (2015) Resection of obstructive left-sided colon cancer at a national level: a prospective analysis of short-term outcomes in 1,816 patients. Dig Surg 32(5):317–324

    Article  PubMed  Google Scholar 

  9. Mealy K, O’Brian E, Donohue J, Tanner A, Kaene FB (1996) Reversible colostomy: what is the outcome? Dis Colon rectum 39:1227–1231

    Article  CAS  PubMed  Google Scholar 

  10. Mauro MA, Koehler RE, Baron TH (2000) Advances in gastrointestinal intervention: the treatment of gastroduodenal and colorectal obstructions with metallic stents. Radiology 215:659–669

    Article  CAS  PubMed  Google Scholar 

  11. Nugent KP, Daniels P, Stewart B, Patankar R, Johnson CD (1999) Quality of life in stoma patients. Dis Colon rectum 42:1569–1574

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  13. 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  CAS  PubMed  Google Scholar 

  14. Bosscher MR, van Leeuwen BL, Hoekstra HJ (2015) Current management of surgical oncologic emergencies. PLoS One 10(5):e0124641

    Article  PubMed  PubMed Central  Google Scholar 

  15. Zhao XD, Cai BB, Cao RS, Shi RH (2013) Palliative treatment for incurable malignant colorectal obstructions: a meta-analysis. World J Gastroenterol 19(33):5565–5574

    Article  PubMed  PubMed Central  Google Scholar 

  16. Maruthachalam K, Lash GE, Shenton BK, Horgan AF (2007) Tumour cell dissemination following endoscopic stent insertion. Br J Surg 94:1151–1154

    Article  CAS  PubMed  Google Scholar 

  17. Erichsen R, Horváth-Puhó E, Jacobsen JB, et al. Long-term mortality and recurrence after colorectal cancer surgery with preoperative stenting: a Danish nationwide cohort study. Endoscopy. 2015

  18. Sloothaak DA, van den Berg MW, Dijkgraaf MG, Fockens P, Tanis PJ, van Hooft JE, Bemelman WA (2014) Oncological outcome of malignant colonic obstruction in the Dutch Stent-In 2 trial. Br J Surg 101(13):1751–1757

    Article  CAS  PubMed  Google Scholar 

  19. Sabbagh C, Browet F, Diouf M, Cosse C, Brehant O, Bartoli E, Mauvais F, Chauffert B, Dupas JL, Nguyen-Khac E, Regumbeau JM (2013) Is stenting as “a bridge to surgery” an oncologically safe strategy for the management of acute, left-sided, malignant, colonic obstruction?: a comparative study with a propensity score analysis. Ann Surg 258:107–115

    Article  PubMed  Google Scholar 

  20. Quereshy FA, Poon JT, Law WL (2014) Long-term outcome of stenting as a bridge to surgery for acute left-sided malignant colonic obstruction. Color Dis 16(10):788–793

    Article  CAS  Google Scholar 

  21. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibanes E, Pekoli J, Slankamenac K, Basse C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196

    Article  PubMed  Google Scholar 

  22. Kolfschoten NE, Wouters MWJM, Gooiker GA, Eddes EH, Kievit J, Tollenaar RA, Marang-van de Mheen PJ (2012) Nonelective colon cancer resections in elderly patients: results from the Dutch surgical colorectal audit. Dig Surg 29:412–419

    Article  CAS  PubMed  Google Scholar 

  23. Hooft JE, Bemelman WA, Oldenburg B, Marinelli AW, Lutke Holzik MF, Grubben MJ, Sprangers MA, Dijkgraaf MG, Fockens P (2011) Colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a multicentre randomised trial. Lancet Oncol 12(4):344–352

    Article  PubMed  Google Scholar 

  24. Martinez-Santos C, Lobato RF, Fradejas JM, Pinto I, Ortega-Debalion P, Moreno-Azcoita M (2002) Self-expandable stent before elective surgery vs. emergency surgery for the treatment of malignant colorectal obstructions: comparison of primary anastomosis and morbidity rates. Dis Colon rectum 45:401–406

    Article  PubMed  Google Scholar 

  25. Young CJ, De-Loyde KJ, Young JM, Solomon MJ, Chew EH, Byrne CM, Salkeld G, Faragher IG (2015) Improving quality of life for people with incurable large-bowel obstruction: randomized control trial of colonic stent insertion. Dis Colon rectum 58(9):838–849

    Article  PubMed  Google Scholar 

  26. Bhangu A, Nepogodiev D, Futaba K (2012) Systematic review and meta-analysis of the incidence of incisional hernia at the site of stoma closure. World J Surg 36:973–983

    Article  PubMed  Google Scholar 

  27. Richtlijn colorectaal carcinoom 2013. Integraal Kanker Centrum Nederland http://oncoline.nl/uploaded/docs/Colorectaal%20carcinoom/Conceptrichtlijn%20Colorectaal%20carcinoom.pdf Accessed at October 20th 2015

  28. 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(3):306–311

    Article  CAS  PubMed  Google Scholar 

  29. van Halsema EE, van Hooft JE, Small AJ, Baron TH, García-Cano J, Cheon JH, Lee MS, Kwon SH, Mucci-Hennekinne S, Fockens P, Dijkgraaf MG, Repici A (2014) Perforation in colorectal stenting: a meta-analysis and a search for risk factors. Gastrointest Endosc 79(6):970–82.e7

    Article  PubMed  Google Scholar 

  30. Kronborg. (1995) Acute obstruction from tumour in the left colon without spread. A randomised trial of emergency colostomy versus resection. Int. J Colorectal Dis 10-1-5.

  31. Amelung FJ, Mulder CLJ, Verheijen PM, Draaisma WA, Siersema PD, Consten ECJ (2015) 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 24:313–321

    Article  PubMed  Google Scholar 

  32. Fielding LP, Stewart-Brown S, Blesovsky L (1979) Large bowel obstruction caused by cancer: a prospective study. BMJ 2:517–519

    Google Scholar 

  33. Gandrup P, Lund L, Balslev I (1992) Surgical treatment of acute malignant large bowel obstruction. Eur J Surg 158:427–430

    CAS  PubMed  Google Scholar 

  34. Huddy SP, Shorthouse AJ, Marks CG (1988) The surgical treatment of intestinal obstruction due to left sided carcinoma of the colon. Ann R Coll Surg Engl 70(1):40–43

    CAS  PubMed  PubMed Central  Google Scholar 

  35. Ragland JJ, Londe AM, Spratt JS Jr (1971) Correlation of the prognosis of obstructing colorectal carcinoma with clinical and pathologic variables. Am J Surg 121(5):552–556

    Article  CAS  PubMed  Google Scholar 

  36. Tan SG, Nambiar R (1995) Resection and anastomosis of obstructed left colonic cancer: primary or staged? Aust N Z J Surg 65(10):728–731 Carson

    Article  CAS  PubMed  Google Scholar 

  37. Carson SN, Poticha SM, Shields TW (1977) Carcinoma obstructing the left side of the colon. Arch Surg 112(4):523–526

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Meander Medical Centre, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands

    Femke J. Amelung, Charlotte L. J. Mulder, Ivo A. M. J. Broeders, Esther C. J. Consten & Werner A. Draaisma

Authors
  1. Femke J. Amelung
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Charlotte L. J. Mulder
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ivo A. M. J. Broeders
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Esther C. J. Consten
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Werner A. Draaisma
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Werner A. Draaisma.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

This paper is not based on previous communication to a society or meeting.

Additional information

This paper was presented as a poster presentation at the 10th anniversary meeting of the European Society of Coloprocotology (ESCP) in Dublin, Ireland, September 23–25, 2015.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Amelung, F.J., Mulder, C.L.J., Broeders, I.A.M.J. et al. Efficacy of loop colostomy construction for acute left-sided colonic obstructions: a cohort analysis. Int J Colorectal Dis 32, 383–390 (2017). https://doi.org/10.1007/s00384-016-2695-2

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-016-2695-2

Keywords

Search

Navigation