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Outcomes for Patients with Obstructing Colorectal Cancers Treated with One-Stage Surgery Using Transanal Drainage Tubes

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Acute colorectal obstruction requires immediate surgical treatment. Although one-stage surgery with transanal drainage tubes (TDT) is reportedly safe and feasible, the long-term outcome of this procedure remains unclear.

Aim

To assess the outcome of one-stage surgery using TDT in the acute left colon or rectal obstructions due to colorectal carcinomas.

Methods

Clinicopathological data were recorded from patients with colorectal cancer with acute obstructions between 2006 and 2013.

Results

A total of 43 patients were enrolled including 29 males and 14 females. Among 39 patients, TDT was successful in 33 (84 %) and was incomplete in 6. Thus, 33 patients received one-stage surgery with TDT decompression, and 9 patients, including 6 with incomplete decompression, received one-stage surgery with no decompression. No significant differences in clinicopathological factors were observed between decompression and non-decompression groups. Adjusted analyses revealed that decompression using TDT was significantly associated with OS (hazard ratio 0.24; 95 % confidence interval, 0.08–0.72; p = 0.01). Furthermore, OS in the TDT decompression group was significantly longer than that in the non-decompression group (p = 0.01).

Conclusions

One-stage surgery with decompression using TDT may be effective to avoid stomas and to improve overall survival in patients with obstructing colorectal cancers.

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References

  1. Ohman U. Prognosis in patients with obstructing colorectal carcinoma. American journal of surgery 1982;143:742–7.

    Article  CAS  PubMed  Google Scholar 

  2. Deans GT, Krukowski ZH, Irwin ST. Malignant obstruction of the left colon. The British journal of surgery 1994;81:1270–6.

    Article  CAS  PubMed  Google Scholar 

  3. Baron TH, Rey JF, Spinelli P. Expandable metal stent placement for malignant colorectal obstruction. Endoscopy 2002;34:823–30.

    Article  CAS  PubMed  Google Scholar 

  4. Deutsch AA, Zelikovski A, Sternberg A, Reiss R. One-stage subtotal colectomy with anastomosis for obstructing carcinoma of the left colon. Diseases of the colon and rectum 1983;26:227–30.

    Article  CAS  PubMed  Google Scholar 

  5. Binkert CA, Ledermann H, Jost R, Saurenmann P, Decurtins M, Zollikofer CL. Acute colonic obstruction: clinical aspects and cost-effectiveness of preoperative and palliative treatment with self-expanding metallic stents—a preliminary report. Radiology 1998;206:199–204.

    Article  CAS  PubMed  Google Scholar 

  6. Murray JJ, Schoetz DJ, Jr., Coller JA, Roberts PL, Veidenheimer MC. Intraoperative colonic lavage and primary anastomosis in nonelective colon resection. Diseases of the colon and rectum 1991;34:527–31.

    Article  CAS  PubMed  Google Scholar 

  7. Terasaka R, Itoh H, Nakafusa Y, Matsuo K. Effectiveness of a long intestinal tube in a one-stage operation for obstructing carcinoma of the left colon. Diseases of the colon and rectum 1990;33:245–8.

    Article  CAS  PubMed  Google Scholar 

  8. Adachi Y, Okita K, Nozoe T, Iso Y, Yoh R, Matsumata T. Long tube for obstructing left-sided colon cancer. Digestive surgery 1999;16:178–9.

    Article  CAS  PubMed  Google Scholar 

  9. Camunez F, Echenagusia A, Simo G, Turegano F, Vazquez J, Barreiro-Meiro I. Malignant colorectal obstruction treated by means of self-expanding metallic stents: effectiveness before surgery and in palliation. Radiology 2000;216:492–7.

    Article  CAS  PubMed  Google Scholar 

  10. Martinez-Santos C, Lobato RF, Fradejas JM, Pinto I, Ortega-Deballon P, Moreno-Azcoita M. Self-expandable stent before elective surgery vs. emergency surgery for the treatment of malignant colorectal obstructions: comparison of primary anastomosis and morbidity rates. Diseases of the colon and rectum 2002;45:401–6.

    Article  PubMed  Google Scholar 

  11. Suzuki N, Saunders BP, Thomas-Gibson S, Akle C, Marshall M, Halligan S. Colorectal stenting for malignant and benign disease: outcomes in colorectal stenting. Diseases of the colon and rectum 2004;47:1201–7.

    Article  PubMed  Google Scholar 

  12. Mucci-Hennekinne S, Kervegant AG, Regenet N, Beaulieu A, Barbieux JP, Dehni N, Casa C, Arnaud JP. Management of acute malignant large-bowel obstruction with self-expanding metal stent. Surgical endoscopy 2007;21:1101–3.

    Article  CAS  PubMed  Google Scholar 

  13. Tanaka T, Furukawa A, Murata K, Sakamoto T. Endoscopic transanal decompression with a drainage tube for acute colonic obstruction: clinical aspects of preoperative treatment. Diseases of the colon and rectum 2001;44:418–22.

    Article  CAS  PubMed  Google Scholar 

  14. Horiuchi A, Nakayama Y, Tanaka N, Kajiyama M, Fujii H, Yokoyama T, Hayashi K. Acute colorectal obstruction treated by means of transanal drainage tube: effectiveness before surgery and stenting. The American journal of gastroenterology 2005;100:2765–70.

    Article  PubMed  Google Scholar 

  15. Yokohata K, Sumiyoshi K, Hirakawa K. Merits and faults of transanal ileus tube for obstructing colorectal cancer. Asian journal of surgery/Asian Surgical Association 2006;29:125–7.

    Article  PubMed  Google Scholar 

  16. Xu M, Zhong Y, Yao L, Xu J, Zhou P, Wang P, Wang H. Endoscopic decompression using a transanal drainage tube for acute obstruction of the rectum and left colon as a bridge to curative surgery. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland 2009;11:405–9.

    Article  CAS  Google Scholar 

  17. Sabbagh C, Chatelain D, Trouillet N, Mauvais F, Bendjaballah S, Browet F, Regimbeau JM. Does use of a metallic colon stent as a bridge to surgery modify the pathology data in patients with colonic obstruction? A case-matched study. Surgical endoscopy 2013;27:3622–31.

    Article  PubMed  Google Scholar 

  18. Horiuchi A, Maeyama H, Ochi Y, Morikawa A, Miyazawa K. Usefulness of Dennis Colorectal Tube in endoscopic decompression of acute, malignant colonic obstruction. Gastrointestinal endoscopy 2001;54:229–32.

    Article  CAS  PubMed  Google Scholar 

  19. Fischer A, Schrag HJ, Goos M, Obermaier R, Hopt UT, Baier PK. Transanal endoscopic tube decompression of acute colonic obstruction: experience with 51 cases. Surgical endoscopy 2008;22:683–8.

    Article  CAS  PubMed  Google Scholar 

  20. McGregor JR, O’Dwyer PJ. The surgical management of obstruction and perforation of the left colon. Surgery, gynecology & obstetrics 1993;177:203–8.

    CAS  Google Scholar 

  21. Biondo S, Perea MT, Rague JM, Pares D, Jaurrieta E. One-stage procedure in non-elective surgery for diverticular disease complications. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland 2001;3:42–5.

    Article  CAS  Google Scholar 

  22. Runkel NS, Schlag P, Schwarz V, Herfarth C. Outcome after emergency surgery for cancer of the large intestine. The British journal of surgery 1991;78:183–8.

    Article  CAS  PubMed  Google Scholar 

  23. Griffith RS. Preoperative evaluation. Medical obstacles to surgery. Cancer 1992;70:1333–41.

    Article  CAS  PubMed  Google Scholar 

  24. Tobaruela E, Camunas J, Enriquez-Navascues JM, Diez M, Ratia T, Martin A, Hernandez P, Lasa I, Martin A, Cambronero JA, Granell J. Medical factors in the morbidity and mortality associated with emergency colorectal cancer surgery. Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva 1997;89:13–22.

    CAS  Google Scholar 

  25. Okamoto K, Fukatsu K, Hashiguchi Y, Ueno H, Shinto E, Moriya T, Saitoh D, Yamamoto J, Hase K. Lack of preoperative enteral nutrition reduces gut-associated lymphoid cell numbers in colon cancer patients: a possible mechanism underlying increased postoperative infectious complications during parenteral nutrition. Annals of surgery 2013;258:1059–64.

    Article  PubMed  Google Scholar 

  26. Kim JS, Hur H, Min BS, Sohn SK, Cho CH, Kim NK. Oncologic outcomes of self-expanding metallic stent insertion as a bridge to surgery in the management of left-sided colon cancer obstruction: comparison with nonobstructing elective surgery. World journal of surgery 2009;33:1281–6.

    Article  PubMed  Google Scholar 

  27. Meisner S, Hensler M, Knop FK, West F, Wille-Jorgensen P. Self-expanding metal stents for colonic obstruction: experiences from 104 procedures in a single center. Diseases of the colon and rectum 2004;47:444–50.

    Article  PubMed  Google Scholar 

  28. Sebastian S, Johnston S, Geoghegan T, Torreggiani W, Buckley M. Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. The American journal of gastroenterology 2004;99:2051–7.

    Article  PubMed  Google Scholar 

  29. Huang X, Lv B, Zhang S, Meng L. Preoperative Colonic Stents Versus Emergency Surgery for Acute Left-Sided Malignant Colonic Obstruction: A Meta-analysis. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 2014;18:584–91.

    Article  Google Scholar 

  30. Bridoux V, Kianifard B, Moutel G, Herve C, Tuech JJ. Stenting as a bridge to surgery for colorectal cancer. The lancet oncology 2011;12:621; author reply -2.

    Article  PubMed  Google Scholar 

  31. Kuss O, Legler T, Borgermann J. Treatments effects from randomized trials and propensity score analyses were similar in similar populations in an example from cardiac surgery. Journal of clinical epidemiology 2011;64:1076–84.

    Article  CAS  PubMed  Google Scholar 

  32. Fernandez-Esparrach G, Bordas JM, Giraldez MD, Gines A, Pellise M, Sendino O, Martinez-Palli G, Castells A, Llach J. Severe complications limit long-term clinical success of self-expanding metal stents in patients with obstructive colorectal cancer. The American journal of gastroenterology 2010;105:1087–93.

    Article  PubMed  Google Scholar 

  33. Abbott S, Eglinton TW, Ma Y, Stevenson C, Robertson GM, Frizelle FA. Predictors of outcome in palliative colonic stent placement for malignant obstruction. The British journal of surgery 2014;101:121–6.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The authors thank A. Asami, K. Takeshima, K. Nagasaki, N. Okamoto, H. Shinozaki, T. Mizutani, and K. Miura for their technical support and helpful discussions.

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Correspondence to Kohei Shigeta.

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Shigeta, K., Baba, H., Yamafuji, K. et al. Outcomes for Patients with Obstructing Colorectal Cancers Treated with One-Stage Surgery Using Transanal Drainage Tubes. J Gastrointest Surg 18, 1507–1513 (2014). https://doi.org/10.1007/s11605-014-2541-1

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  • DOI: https://doi.org/10.1007/s11605-014-2541-1

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