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Surgery for synchronous and metachronous colorectal cancer: segmental or extensive colectomy?

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Abstract

Purpose

To assess the impact of surgical approach on morbidity, mortality, and the oncological outcomes of synchronous (SC) and metachronous (MC) colorectal cancer (CRC).

Methods

All patients undergoing resection for double location CRC (SC or MC) between 2006 and 2020 were included. The exclusion criteria were polyposis or SC located on the same side.

Results

Sixty-seven patients (age, 64.8 years; male, 78%) with SC (n = 41; 61%) or MC (n = 26; 39%) were included. SC was treated with segmental colectomy (right and left colectomy/proctectomy; n = 19) or extensive colectomy (subtotal/total colectomy or restorative proctocolectomy with pouch; n = 22). Segmental colectomy was associated with a higher incidence of anastomotic leakage (47.4 vs. 13.6%; p = 0.04) and a higher rate of medical morbidity (47.4 vs. 16.6%; p = 0.04). The mean number of lymph nodes harvested was similar. For MC, the second cancer was treated by iterative colectomy (n = 12) or extensive colectomy (n = 14) and there was no significant difference in postoperative outcomes between the two surgical approaches. The median follow-up period was 42.4 ± 29.1 months. The 5-year overall and disease-free survival of the SC and MC groups did not differ to a statistically significant extent.

Conclusions

Extensive colectomy should be preferred for SC to reduce morbidity and improve the prognosis. In contrast, iterative colectomy can be performed safely for patients with MC.

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Data availability

On request to the corresponding author.

Code availability

Not applicable.

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Authors and Affiliations

  1. Department of Digestive Surgery, Sorbonne Université, AP-HP, Hôpital Saint Antoine, 184 rue du faubourg Saint-Antoine, 75012, Paris, France

    Jeremy Nguyen, Jeremie H. Lefèvre, Cecile Bouchet-Doumenq, Thibault Voron, Najim Chafaï, Clotilde Debove & Yann Parc

  2. Mater Misericordiae University Hospital, Dublin, Ireland

    Ben Creavin

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  1. Jeremy Nguyen
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  2. Jeremie H. Lefèvre
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  3. Cecile Bouchet-Doumenq
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Correspondence to Jeremie H. Lefèvre.

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Nguyen, J., Lefèvre, J.H., Bouchet-Doumenq, C. et al. Surgery for synchronous and metachronous colorectal cancer: segmental or extensive colectomy?. Surg Today 53, 338–346 (2023). https://doi.org/10.1007/s00595-022-02624-2

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  • DOI: https://doi.org/10.1007/s00595-022-02624-2

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