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Yu DF, Yang L, Wang C, Zhou ZG. Intraoperative two-way versus one-way irrigation in patients with obstructed left-sided colorectal cancer: A retrospective study. Asian J Surg 2023; 46:3856-3857. [PMID: 37031084 DOI: 10.1016/j.asjsur.2023.03.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 03/22/2023] [Indexed: 04/08/2023] Open
Affiliation(s)
- Deng-Feng Yu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China; Department of General Surgery, Dalian University Affiliated Xinhua Hospital, Dalian, 116021, China
| | - Lie Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China; Institute of Digestive Surgery & State Key Laboratory of Biotherapy, Sichuan University, Chengdu, 610041, China
| | - Cun Wang
- Colorectal Cancer Center, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zong-Guang Zhou
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China; Colorectal Cancer Center, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Institute of Digestive Surgery & State Key Laboratory of Biotherapy, Sichuan University, Chengdu, 610041, China.
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Yu DF, Yang L, Wang C, Zhou ZG. Intraoperative two-way irrigation versus one-way irrigation in patients with obstructed left-sided colorectal cancer: A retrospective study. Asian J Surg 2023:S1015-9584(22)01818-8. [PMID: 36635173 DOI: 10.1016/j.asjsur.2022.12.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 12/22/2022] [Indexed: 01/12/2023] Open
Affiliation(s)
- Deng-Feng Yu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China; Department of General Surgery, Dalian University Affiliated Xinhua Hospital, Dalian, 116021, China
| | - Lie Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China; Institute of Digestive Surgery & State Key Laboratory of Biotherapy, Sichuan University, Chengdu, 610041, China
| | - Cun Wang
- Colorectal Cancer Center, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zong-Guang Zhou
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China; Colorectal Cancer Center, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Institute of Digestive Surgery & State Key Laboratory of Biotherapy, Sichuan University, Chengdu, 610041, China.
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TOPÇU R, YILDIZ BD, AKIN T, BERKEM H, ER S, ULUSOY C, KENDİRCİ M, YÜKSEL BC, ÖZEL İH, HENGİRMEN S. Retrospective analysis of acute left colon obstructions due to colorectal cancers. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2020. [DOI: 10.32322/jhsm.712406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Ascanelli S, Navarra G, Tonini G, Feo C, Zerbinati A, Pozza E, Carcoforo P. Early and Late Outcome after Surgery for Colorectal Cancer Elective versus Emergency Surgery. TUMORI JOURNAL 2018; 89:36-41. [PMID: 12729359 DOI: 10.1177/030089160308900108] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and Background Emergency surgery for colorectal cancer is associated with a higher postoperative morbidity and mortality rate and a poor long-term outcome compared with elective surgery. The aim of the present study was to compare early and late outcome after elective and emergency surgery for malignant colorectal cancer, looking for the principal determinants of a worse outcome after emergency colorectal surgery. Methods A retrospective study of 236 patients presenting with colorectal cancer over an 8-year period was undertaken. Of these, 118 presented as emergencies, whereas 118 patients, well matched for age, sex, site of tumor and TNM admitted as elective, were included in the study. Data reviewed included postoperative mortality and morbidity and long-term outcome. Results The 30-day operative mortality rate was significantly higher in the emergency group than in the electively treated group (11.9% versus 3.4%, P<0.01). The higher mortality rate was observed in the perforation group. The 30-day operative morbidity was higher in the emergency group (27.1% versus 12.7%, P <0.05). Anastomotic failure was a serious complication: following primary resection, we observed 4 non-fatal (5.4%) and two fatal (2.7%) anastomotic leaks after 74 primary anastomoses. Among emergency-treated patients, the procedures characterized by the highest percentage of postoperative complications were three-stage resections (63.6%). The 5-year survival rate was greater after elective surgery (59% versos 39%). Conclusions The early and long-term outcome following emergency colorectal surgery was significantly lower than that after elective surgery. Although medical complications in patients with end-stage cancer played an important role, surgical failures still had an important impact on outcome.
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Effectiveness of Laparoscopic Surgery for Obstructive Colorectal Cancer After Tube Decompression. Surg Laparosc Endosc Percutan Tech 2017; 26:343-6. [PMID: 27403619 DOI: 10.1097/sle.0000000000000295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND It is debatable whether laparoscopic surgery is suitable for obstructive colorectal cancer. MATERIALS AND METHODS We retrospectively reviewed the clinical and oncological effectiveness of laparoscopic surgery after tube decompression for obstructive colorectal cancer in 54 patients (18 laparoscopic resections, 36 open resections). RESULTS There were no significant differences between groups with respect to mean size, location, depth, and stage of tumor, median operating times, or median number of lymph nodes retrieved. Abdominal wound infection rate was significantly lower in the laparoscopic than in the open group (0%:22%, P=0.02), as were mean times to first gas passage after surgery (2.3:3.4 d, P=0.002) and mean postoperative hospital stays (16:24.3 d, P=0.03). The 3-year disease-free survival rate of curative resection cases in the laparoscopic (85%) and open (72%) groups were not significantly different. CONCLUSIONS Laparoscopic surgery after tube decompression achieves faster recovery and equal oncological outcome as open surgery and should be a treatment of choice for obstructive colorectal cancer.
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Sucullu I, Ozdemir Y, Cuhadar M, Balta AZ, Yucel E, Filiz AI, Gulec B. Comparison of emergency surgeries for obstructed colonic cancer with elective surgeries: A retrospective study. Pak J Med Sci 2016; 31:1322-7. [PMID: 26870090 PMCID: PMC4744275 DOI: 10.12669/pjms.316.8277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective: Colon cancer patients presented with obstruction were known to have worse postoperative morbidity and mortality rates, but conflicting data has been reported in recent years. We aimed to investigate postoperative complication rates, and short and long-term oncological outcomes in patients with colon cancer treated with either emergency surgery due to obstruction or elective surgery. Methods: Two hundred fifty two patients were analyzed. Patients presented with obstruction and underwent an emergency surgery, and patients operated under elective circumstances were compared according to their demographic variables, tumor characteristics, and short and long term treatment outcomes. Results: Distribution of age, gender and comorbidities were similar between both the groups. Need for an end colostomy was significantly higher in obstructed patients (22.7% vs 1.6%, respectively). Obstructed patients were tending to be at an advanced stage. Postoperative morbidity and mortality, and prognosis of colon cancer patients presented with obstruction is worse than patients operated under elective circumstances. Conclusions: Colon cancer patients presented with obstruction constitutes more than one quarter of all patients. These patients have significantly higher morbidity and mortality rates. Obstructed colon cancer usually appears at advanced stage. Primary resection and anastomosis is safe in most of the cases.
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Affiliation(s)
- Ilker Sucullu
- Ilker Sucullu, Associate Professor, Department of General Surgery, GATA Haydarpasa Training Hospital, Istanbul, Turkey
| | - Yavuz Ozdemir
- Yavuz Ozdemir, Assistant Professor, Department of General Surgery, GATA Haydarpasa Training Hospital, Istanbul, Turkey
| | - Mehmet Cuhadar
- Mehmet Cuhadar, Resident Doctor, Department of General Surgery, GATA Haydarpasa Training Hospital, Istanbul, Turkey
| | - Ahmet Ziya Balta
- Ahmet Ziya Balta, Associate Professor, Department of General Surgery, GATA Haydarpasa Training Hospital, Istanbul, Turkey
| | - Ergun Yucel
- Ergun Yucel, Associate Professor, Department of General Surgery, GATA Haydarpasa Training Hospital, Istanbul, Turkey
| | - Ali Ilker Filiz
- Ali Ilker Filiz, Associate Professor, Department of General Surgery, GATA Haydarpasa Training Hospital, Istanbul, Turkey
| | - Bulent Gulec
- Bulent Gulec, Professor, Department of General Surgery, GATA Haydarpasa Training Hospital, Istanbul, Turkey
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Rho SY, Bae SU, Baek SJ, Hur H, Min BS, Baik SH, Lee KY, Kim NK. Feasibility and safety of laparoscopic resection following stent insertion for obstructing left-sided colon cancer. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2013; 85:290-5. [PMID: 24368987 PMCID: PMC3868681 DOI: 10.4174/jkss.2013.85.6.290] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 08/22/2013] [Accepted: 09/25/2013] [Indexed: 11/30/2022]
Abstract
Purpose The aim of this study was to assess the feasibility and safety of laparoscopic resection following the insertion of self-expanding metallic stents (SEMS) for the treatment of obstructing left-sided colon cancer. Methods Between October 2006 and December 2012, laparoscopic resection following SEMS insertion was performed in 54 patients with obstructing left-sided colon cancer. Results All 54 procedures were technically successful without the need for conversion to open surgery. The median interval from SEMS insertion to laparoscopic surgery was 9 days (range, 3-41 days). The median surgery time was 200 minutes (range, 57-444 minutes), and estimated blood loss was 50 mL (range, 10-3,500 mL). The median time to soft diet was 4 days (range, 2-8 days) and possible length of stay (hypothetical length of stay according to the discharge criteria) was 7 days (range, 4-22 days). The median total number of lymph nodes harvested was 23 (range, 8-71) and loop ileostomy was performed in 2 patients (4%). Six patients (11%) developed postoperative complications: 2 patients with anastomotic leakages, 1 with bladder leakage, and 3 with ileus. There was no mortality within 30 days. Conclusion The present study shows that the presence of a SEMS does not compromise the laparoscopic approach. Laparoscopic resection following stent insertion for obstructing left-sided colon cancer could be performed with a favorable safety profile and short-term outcome. Large-scale comparative studies with long-term follow-up are needed to demonstrate a significant benefit of this approach.
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Affiliation(s)
- Seoung Yoon Rho
- Division of Colorectal Surgery, Department of Surgery, Colorectal Cancer Clinic, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Uk Bae
- Division of Colorectal Surgery, Department of Surgery, Colorectal Cancer Clinic, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Se Jin Baek
- Division of Colorectal Surgery, Department of Surgery, Colorectal Cancer Clinic, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyuk Hur
- Division of Colorectal Surgery, Department of Surgery, Colorectal Cancer Clinic, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Soh Min
- Division of Colorectal Surgery, Department of Surgery, Colorectal Cancer Clinic, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Hyuk Baik
- Division of Colorectal Surgery, Department of Surgery, Colorectal Cancer Clinic, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kang Young Lee
- Division of Colorectal Surgery, Department of Surgery, Colorectal Cancer Clinic, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Nam Kyu Kim
- Division of Colorectal Surgery, Department of Surgery, Colorectal Cancer Clinic, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Colorectal resection after stent insertion for obstructing cancer: comparison between open and laparoscopic approaches. Surg Laparosc Endosc Percutan Tech 2013; 23:29-32. [PMID: 23386146 DOI: 10.1097/sle.0b013e318275743b] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
AIM To evaluate surgical outcomes after stent insertion for obstructing colorectal malignancy and to compare between laparoscopic and open approach. METHODS Surgical resection was performed after stent insertion for malignant colorectal obstruction in 36 patients with a median age of 73 years. Eighteen patients were treated with open resection, whereas 18 underwent a laparoscopic resection. The outcomes were evaluated and comparison was made between patients with laparoscopic and open resection. RESULTS The mean interval between stent insertion and surgery was 11 days. One patient died within 30 days (2.8%). The overall incidence of postoperative morbidity was 22% and reoperation was required in 3 patients (8.8%). The median postoperative hospital stay was 8.5 days for the open surgery group and 5.5 days for the laparoscopic group (P = 0.004). The postoperative morbidity rates for the open and laparoscopic groups were 33.3% and 11.1%, respectively (P = 0.228). In those patients with nonmetastatic disease, with the median follow-up of 20 months, the 5-year survival rate was 49.5%. CONCLUSIONS Our experience showed that after successful endoscopic stent insertion for malignant colorectal obstruction, elective surgical resection could be performed safely. The combined endoscopic and laparoscopic procedure provides a less invasive alternative to the multistage open operations and is feasible for patients with obstructing colon cancer.
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One-stage segmental colectomy and primary anastomosis after intraoperative colonic irrigation and total colonoscopy for patients with obstruction due to left-sided colorectal cancer. Dis Colon Rectum 2012; 55:72-8. [PMID: 22156870 DOI: 10.1097/dcr.0b013e318239be5e] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Intraoperative colonic irrigation and intraoperative on-table colonoscopy may be useful for a more accurate diagnosis of colorectal cancer before colectomy in patients with obstructive left-sided colorectal cancer, but the clinical benefit of this technique has not been investigated in large-scale studies. OBJECTIVE The aim of this study was to evaluate the usefulness of intraoperative colonic irrigation with a Y-shaped irrigation device and intraoperative colonoscopy in the management of obstructive colorectal cancer in patients undergoing elective surgery. DESIGN AND SETTING This was a retrospective cohort study of patients undergoing surgical treatment at a single tertiary care institution in Japan. PATIENTS AND INTERVENTION Among 715 consecutive patients with left-sided colorectal cancer, 101 patients (14.1%) with obstructing tumor received intraoperative colonic irrigation and intraoperative colonoscopy before colectomy and primary anastomosis, and 614 patients with nonobstructive colorectal cancer underwent preoperative colonoscopy with mechanical bowel preparation. MAIN OUTCOME MEASURES Detection rates of proximal synchronous lesions, occurrence of postoperative complications, and changes in the surgical procedure prompted by the results of the intraoperative colonoscopy were evaluated. RESULTS Intraoperative colonoscopy detected synchronous adenomatous polyps in 27 patients (26.8%), carcinoma in 4 patients (4%), and obstructive colitis in 2 patients (2%). Findings of the intraoperative colonoscopy prompted changes in surgical procedure in 9 patients (8.9%). The overall morbidity in the intraoperative group was 17%, with anastomotic leakages in 3 patients, wound infection in 5, and postoperative ileus in 3 patients. The risk of these complications was not increased in patients with intraoperative colonoscopy with intraoperative colonic irrigation compared with those receiving preoperative colonoscopy with mechanical bowel preparation. The operation time was 28 minutes longer in the intraoperative than in the preoperative group, but neither the time to start of oral intake nor the length of postoperative hospital stay was significantly different between the 2 groups. LIMITATIONS The study is limited by its retrospective nature. CONCLUSIONS : In patients with obstructive colorectal cancer, intraoperative colonic irrigation with intraoperative colonoscopy is a useful strategy for detecting synchronous lesions located proximally to the obstructing tumor, without increasing patient morbidity.
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Surgery for obstructed colorectal malignancy in an Asian population: predictors of morbidity and comparison between left- and right-sided cancers. J Gastrointest Surg 2010; 14:295-302. [PMID: 19894082 DOI: 10.1007/s11605-009-1074-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2009] [Accepted: 10/16/2009] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Surgical treatment of obstructed colorectal cancers has been associated with significant perioperative morbidity and mortality. This study was performed to review the spectrum of surgery and early outcome of patients with acutely obstructed colorectal cancers. The secondary aims were to compare right- and left-sided obstruction and to identify factors predicting morbidity and mortality in these patients. METHODS A retrospective review of all patients who underwent operative intervention for acute obstruction from colorectal malignancy from February 2003 to April 2008 was performed. Patients were identified from the hospital's operating records based on postoperative diagnosis codes of colorectal malignancy. The diagnosis of acute obstruction was confirmed through clinical assessment, radiological investigations, and surgical findings. All the complications were graded according to the classification proposed by Clavien and group. RESULTS Out of a total of 1,268 patients who underwent surgery for colorectal malignancy, 134 (10.6%) patients with a median age of 71 years (range, 34-97 years) were operated for acute obstruction. Left-sided malignancy accounted for 79.9% of the obstruction, with sigmoid colon being the most common site in 54 (40.3%) patients. A significant proportion (77.6%) of our patients had associated perioperative morbidity, and the mortality rate was 11.9%. Worse complications (grades of complications III to V) were more frequent in patients who had a higher American Society of Anesthesiologists score (3-4), are > or = 60 years old, and had preoperative renal impairment. Stoma was created more frequently in left-sided pathology. CONCLUSION In an Asian population, surgery in patients with acute colorectal malignant obstruction is associated with significant morbidity and mortality rates. Though left-sided malignant obstruction occurs more frequently and is associated with a higher incidence of stoma creation, primary resection and anastomosis is a safe option in selected patients.
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Systematic review of intraoperative colonic irrigation vs. manual decompression in obstructed left-sided colorectal emergencies. Int J Colorectal Dis 2009; 24:1031-7. [PMID: 19415306 DOI: 10.1007/s00384-009-0723-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2009] [Indexed: 02/04/2023]
Abstract
AIMS A systematic review was conducted to determine if manual decompression is a safe alternative to intraoperative colonic irrigation prior to primary anastomosis in obstructed left-sided colorectal emergencies. METHODS Search for relevant articles from 1980 to 2007 was conducted on Medline, Embase and the Cochrane Controlled Trials Register using the keywords "colonic lavage, irrigation, decompression, washout, obstructed and bowel preparation", either singularly or in combination. Trials in English publications with similar patient characteristics, inclusion criteria and outcome measures were selected for analysis. Thirty-day mortality, anastomotic leak rates and post-operative wound infection were studied as outcome variables. Analysis was performed with RevMan 4.2 software. RESULTS Seven trials were identified for systematic review, with a total of 449 patients. Data from the single randomised controlled trial and one prospective comparative trial were analysed separately. Results from the remaining five studies were pooled into two arms of a composite series, one with colonic irrigation and one without. Results showed no significant difference in the anastomotic leak rates and mortality rates between the colonic irrigation and manual decompression arms in the randomised and comparative trials. The composite series, however, showed significantly better results with manual decompression (RR 6.18, 95% CI 1.67-22.86). The post-operative infection rate was similar in both groups. CONCLUSION Manual decompression was comparable to colonic irrigation for primary anastomosis in obstructed left-sided colorectal emergencies, with no significant increase in mortality, leak or infection rates.
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Coban S, Yilmaz M, Terzi A, Yildiz F, Ozgor D, Ara C, Yologlu S, Kirimlioglu V. Resection and primary anastomosis with or without modified blow-hole colostomy for sigmoid volvulus. World J Gastroenterol 2008; 14:5590-4; discussion 5593. [PMID: 18810779 PMCID: PMC2746348 DOI: 10.3748/wjg.14.5590] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the efficacy of resection and primary anastomosis (RPA) and RPA with modified blow-hole colostomy for sigmoid volvulus.
METHODS: From March 2000 to September 2007, 77 patients with acute sigmoid volvulus were treated. A total of 47 patients underwent RPA or RPA with modified blow-hole colostomy. Twenty-five patients received RPA (Group A), and the remaining 22 patients had RPA with modified blow-hole colostomy (Group B). The clinical course and postoperative complications of the two groups were compared.
RESULTS: The mean hospital stay, wound infection and mortality did not differ significantly between the groups. Superficial wound infection rate was higher in group A (32% vs 9.1%). Anastomotic leakage was observed only in group A, with a rate of 6.3%. The difference was numerically impressive but was statistically not significant.
CONCLUSION: RPA with modified blow-hole colostomy provides satisfactory results. It is easy to perform and may become a method of choice in patients with sigmoid volvulus. Further studies are required to further establish its role in the treatment of sigmoid volvulus.
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Results of surgery for colorectal carcinoma with obstruction. Langenbecks Arch Surg 2008; 394:49-53. [PMID: 18299883 DOI: 10.1007/s00423-008-0307-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2007] [Accepted: 01/31/2008] [Indexed: 12/31/2022]
Abstract
BACKGROUND/AIMS Emergency surgery for obstructing colorectal carcinoma is thought to be associated with poor survival. The aim of the study is to assess the results of surgery for obstructing colorectal cancer. MATERIALS AND METHODS From 1987 to 2004, 80 patients underwent emergency surgery for completely obstructing colorectal carcinoma (COC), and 171 patients underwent elective surgery for non-obstructing cancer (NOC). Morbidity, mortality, and the late outcome were assessed. RESULTS The groups were comparable for age, gender, tumor distribution, histopathologic characteristics, stage, morbidity, concomitant operations, recurrence, and sites of recurrence. High ASA class, poor performance status, and high mortality rate were recorded in COC group (p < 0.05). Mortality was related to ASA class (p < 0.001), performance status (p < 0.001), and obstruction (p = 0.014). ASA class was the single independent factor of morbidity (p < 0.001). The groups were comparable for survival (p > 0.05). CONCLUSIONS Obstructing colorectal carcinoma seems to be associated with high mortality rate, but long-term survival seems to be the same with non-obstructing carcinoma.
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Breitenstein S, Rickenbacher A, Berdajs D, Puhan M, Clavien PA, Demartines N. Systematic evaluation of surgical strategies for acute malignant left-sided colonic obstruction. Br J Surg 2007; 94:1451-60. [PMID: 17968980 DOI: 10.1002/bjs.6007] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Surgical strategy for acute colorectal obstruction due to colorectal cancer remains controversial. One-, two- and three-stage surgical procedures, and preoperative stenting of the stenosis as a bridge to surgery, are available. METHODS A systematic review was conducted, searching MEDLINE, EMBASE and CENTRAL, as well as bibliographies of included studies, to identify randomized and non-randomized controlled trials that compared two or more surgical procedures in acute colonic obstruction. RESULTS After screening 1748 titles and abstracts, 209 were selected for full text assessment; 29 studies with 2286 patients were finally included. In general, the quality of the studies was limited, with only three randomized trials. Eight non-randomized studies comparing one-stage with two- or three-stage surgery consistently favoured a one-stage procedure in terms of mortality (relative risk difference from - 2 to - 27 per cent), but reported morbidity rates were not different. Trials of different one-stage procedures (segmental and total/subtotal colectomy) showed none to be clearly superior. Stenting procedures were superior to non-stenting treatments. CONCLUSION One-stage surgery appears to be superior to two- or three-stage procedures. Stenting is a promising option, allowing the resection to be carried out in an elective setting.
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Affiliation(s)
- S Breitenstein
- Department of Visceral and Transplantation Surgery, Zurich, Switzerland
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Finan PJ, Campbell S, Verma R, MacFie J, Gatt M, Parker MC, Bhardwaj R, Hall NR. The management of malignant large bowel obstruction: ACPGBI position statement. Colorectal Dis 2007; 9 Suppl 4:1-17. [PMID: 17880381 DOI: 10.1111/j.1463-1318.2007.01371.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- P J Finan
- Department of Colorectal Surgery, General Infirmary at Leeds, Leeds, UK.
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Rana AR, Cannon JA, Mostafa G, Carbonell AM, Kercher KW, Norton HJ, Heniford BT. Outcomes of right- compared with left-side colectomy. Surg Innov 2007; 14:91-5. [PMID: 17558013 DOI: 10.1177/1553350607303209] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Right colon resections are perceived as less morbid than left colon resections. The purpose of this study was to determine the differences in outcomes between right-and left-side colon resections. We reviewed 420 consecutive open colectomies over 4 years. Patient demographics, surgical indications, intraoperative variables, and outcomes were collected. Two hundred twenty-three right colectomies (RCs) were compared with 197 left colectomies (LCs). RCs were more often required for cancer (111 vs 65, P < .001) and LCs for diverticular disease (10 vs 90, P < .001). LCs were more often performed emergently (36% vs 23%, P = .004) and required longer mean operative times (149 minutes vs 130 minutes, P = .004). Complications and mortality in the two groups were equal statistically. In the emergent colectomy subset, LCs were associated with greater intraoperative blood loss (315 vs 201 mL, P = .02) but fewer complications (11% vs 17%, P = .003).
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Affiliation(s)
- Ankur R Rana
- Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, North Carolina 28203, USA
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Huang WS, Liu KW, Lin PY, Hsieh CC, Wang JY. Delayed ischemic gangrene change of distal limb despite optimal decompressed colostomy constructed in obstructed sigmoid colon cancer: A case report. World J Gastroenterol 2006; 12:993-5. [PMID: 16521237 PMCID: PMC4066174 DOI: 10.3748/wjg.v12.i6.993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Creating blow-hole colostomy for decompression could provide a time-saving and efficient surgical procedure for a severely debilitated case with a completely obstructed colorectal cancer. Complications are reported as prolapse, retraction, and paracolostomal abscess. However, complication with an ischemic distal limb has not been reported. We report a case of critical intra-abdominal disease after decompressed colostomy for relieving malignant sigmoid colon obstruction; a potential fatal condition should be alerted. A 76-year-old male visited our emergency department for symptoms related to obstructed sigmoid colon tumor with foul-odor vomitus containing fecal-like materials. An emergent blow-hole colostomy proximal to an obstructed sigmoid lesion was created, and resolution of complete colon obstruction was pursued. Unfortunately, extensive abdominal painful distention with board-like abdomen and sudden onset of high fever with leukocytopenia developed subsequently. Such surgical abdomen rendered a secondary laparotomy with resection of the sigmoid tumor along with an ischemic colon segment located proximally up to the previously created colostomy. Eventually, the patient had an uneventful postoperative hospital stay. In the present article, we have described an emergent condition of sudden onset of distal limb ischemia after blow-hole colostomy and concluded that despite the decompressed colostomy would resolve acute malignant colon obstruction efficiently; impending ischemic bowel may progress with a possible irreversible peritonitis. Any patient, who undergoes a decompressed colostomy without resection of the obstructed lesion, should be monitored with leukocyte count and abdominal condition survey frequently.
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Affiliation(s)
- Wen-Shih Huang
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, and Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, Taiwan, China
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Kim JH, Shon DH, Kang SH, Jang BI, Chung MK, Kim JH, Shim MC. Complete single-stage management of left colon cancer obstruction with a new device. Surg Endosc 2005; 19:1381-7. [PMID: 16151681 DOI: 10.1007/s00464-004-8232-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2005] [Accepted: 03/28/2005] [Indexed: 12/14/2022]
Abstract
BACKGROUND A newly developed device that enables easy intraoperative colonic irrigation and subsequent colonoscopy was introduced recently. METHODS To evaluate the efficacy of the single-stage procedure with a new device and the significance of on-table colonoscopy, 112 patients with obstructive left colon cancer were recruited. RESULTS Primary anastomosis after tumor resection was performed in 104 cases. The volume of saline used for irrigation averaged 13.5 l over 12.1 min. Subsequent colonoscopic examination added an average of 10.4 min to the operative time. There were three anastomotic leaks, two wound infections, four acute renal failures, and two operative mortalities. On-table colonoscopy resulted in extended resection in 17 cases. CONCLUSIONS The new device enabled safe, simple, and time-saving, single-stage surgical management of left colon cancer obstruction. The ability to perform on-table colonoscopy enabled treatment and recognition of synchronous bowel pathology.
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Affiliation(s)
- J-H Kim
- Department of Surgery [corrected], College of Medicine, Yeungnam University, 317-1 Daemyungdong Namku, Daegu, 705-717, Korea
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19
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Patriti A, Contine A, Carbone E, Gullà N, Donini A. One-stage resection without colonic lavage in emergency surgery of the left colon. Colorectal Dis 2005; 7:332-8. [PMID: 15932554 DOI: 10.1111/j.1463-1318.2005.00812.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Intra-operative colonic lavage is a widespread procedure introduced to decompress and clean the colon of its faecal load during emergency surgery of the left colon in order to perform a safe anastomosis. This type of lavage is never performed at our institution. The aim of this study was to evaluate the safety and acceptability of emergency left-sided colectomy without colonic lavage in a consecutive series of patients admitted at our department for perforation and obstruction of the left colon. PATIENTS AND METHODS All 44 patients (29 with obstruction and 15 with perforation) on whom a one-stage left-sided colon resection was performed without colonic lavage between January 1998 and June 2004 were evaluated in a retrospective review. During this period all patients with acute disease of the left colon underwent a one stage resection without colonic lavage. The only exclusion criteria for anastomosis were: haemodynamic instability, ASA > 3, unresectable tumour. Death, anastomotic leakage and wound infection were main outcome measures. RESULT The leak rate was 4.5% and mortality 2.3% due to one case of postoperative myocardial infarction. A 16% morbidity rate was recorded due to 4 wound infections and 3 minor complications. CONCLUSION The procedure is safe. The low morbidity and mortality of one stage resection without colonic lavage can justify future prospective studies enrolling a large number of patients to compare its results with those obtained by one stage resection with colonic lavage.
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Affiliation(s)
- A Patriti
- General and Emergency Surgery, Department of Surgery, University of Perugia, Perugia, Italy.
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20
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21
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Law WL, Choi HK, Chu KW. Comparison of stenting with emergency surgery as palliative treatment for obstructing primary left-sided colorectal cancer. Br J Surg 2003; 90:1429-33. [PMID: 14598426 DOI: 10.1002/bjs.4311] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Self-expanding metallic stents provide an alternative to surgery as definitive palliation in patients with obstructing colorectal cancer. This study aimed to compare the outcome of patients with obstruction due to primary left-sided colorectal cancer treated by palliative stenting with outcome in patients who had undergone surgery. METHODS Patients with incurable obstructing primary colorectal cancer distal to the splenic flexure treated with emergency surgery (n = 31) or placement of a metallic stent (n = 30) from November 1997 to June 2002 were included. Data on the mortality, morbidity, necessity of intensive care and hospital stay for the two groups were compared. The subsequent outcomes, including the incidence of stoma creation and survival, were also analysed. RESULTS The two groups were similar in terms of age, sex distribution and presence of co-morbidity. Insertion of metallic stents was successful in 29 of 30 patients. Hospital death occurred in four and eight patients in the study and control groups respectively (P = 0.335). Fewer patients with placement of a stent required intensive care (1 versus 11; P = 0.001) and the median hospital stay was shorter in patients with stenting (4 versus 8 days; P = 0.008). A stoma was subsequently created in four patients with stenting, whereas 15 patients who had emergency operation required a stoma (P = 0.005). The difference in median survival between the two groups was not statistically significant (107 versus 119 days; P = 0.088). CONCLUSION Self-expanding metallic stents are effective in the palliation of obstructing colorectal cancer. Placement of stents is associated with a shorter hospital stay, less likelihood of intensive care and a lower incidence of stoma creation, when compared with emergency surgery. Thus insertion of a metallic stent should be considered in patients with incurable obstructing colorectal cancer.
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Affiliation(s)
- W L Law
- Department of Surgery, Queen Mary Hospital, University of Hong Kong Medical Centre, Pokfulam Road, Hong Kong, China.
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22
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Abstract
The medical community should become mobilized to diagnose colon cancer earlier in pregnancy to improve prognosis. The primary care physician or obstetrician should refer the pregnant patient with significant gastrointestinal complaints to the gastroenterologist for evaluation. Likewise, the gastroenterologist should be prepared to perform sigmoidoscopy, preferably without endoscopic medications, for significant lower gastrointestinal symptoms such as persistent rectal bleeding. Sigmoidoscopy is particularly sensitive in identifying colon cancer in pregnant patients because their cancers are usually distal and within reach of the sigmoidoscope.
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Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology, Department of Medicine, Woodhull Medical Center, 760 Broadway Avenue, Brooklyn, NY 11206, USA
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23
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Abstract
There are many indications for surgical intervention in the current treatment of cancer of the colon and rectum. The hallmark of surgical therapy remains en bloc resection of the primary tumor, accompanied by removal of the mesenteric lymph nodes. Surgical resection is also the principal and most successful treatment for local recurrences and isolated metastases. Although the application of minimally invasive techniques is growing in all aspects of surgery and is accepted in the treatment of benign lesions of the colon, laparoscopic resection for colorectal cancer cannot be recommended apart from randomized, controlled trials. Similarly, the role of sentinel lymph node biopsy in the surgical treatment of colorectal cancer remains to be defined. Various surgical modalities have been developed for the treatment of unresectable colorectal cancer metastatic to the liver. Further studies should help to elucidate the exact role of these therapies in the treatment of this common clinical problem. In summary, surgical treatment plays an important role in multiple aspects of the care of the patient with colorectal cancer.
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Affiliation(s)
- Robert J Canter
- Department of Surgery, Hospital of the University of Pennsylvania, 4 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104, USA
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24
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Lee YM, Law WL, Chu KW, Poon RT. Emergency surgery for obstructing colorectal cancers: a comparison between right-sided and left-sided lesions. J Am Coll Surg 2001; 192:719-25. [PMID: 11400965 DOI: 10.1016/s1072-7515(01)00833-x] [Citation(s) in RCA: 167] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Fifteen to twenty percent of patients with primary colorectal cancers present with intestinal obstruction. Traditionally, different approaches have been used in the management of right-sided and left-sided colonic obstruction. Recently, single-stage resection with primary anastomosis in left colonic obstruction has been shown to have good results. The objective of this study was to compare the operative results of patients who had emergency operations for right-sided and left-sided obstructions from primary colorectal cancers. STUDY DESIGN This is a retrospective study including 243 patients who underwent emergency operations for obstructing colorectal cancers from 1989 to 1997. Primary resection of the tumor-bearing segment followed by primary anastomosis was attempted when the conditions were feasible. The operative results of patients with right-sided tumors were compared with those of patients with left-sided tumors. RESULTS One hundred seven patients had obstruction at or proximal to the splenic flexure (right-sided lesions), and 136 had lesions distal to the splenic flexure (left-sided lesions). The primary resection rate was 91.8%. Of the 223 patients with primary resection, primary anastomosis was possible in 197 patients. Among the 101 primary anastomoses in patients with left-sided obstruction, segmental resection with on-table lavage was performed in 75 patients and subtotal colectomy was performed in 26. The overall operative mortality rate was 9.4%, although that of the patients with primary resection and anastomosis was 8.1%. The anastomotic leakage rate for those with primary resection and anastomosis was 6.1%. There were no differences in the mortality or leakage rates between patients with right-sided and left-sided lesions (mortality: 7.3% versus 8.9%, p = 0.79; leakage: 5.2% versus 6.9%, p = 0.77). Colocolonic anastomosis did not show a significant difference in leakage rate when compared with ileocolonic anastomosis (6.1% versus 6.0%, p = 1.0). CONCLUSIONS This study showed that primary resection and anastomosis for left-sided malignant obstruction, either by segmental resection with on-table lavage or subtotal colectomy, was not more hazardous than primary anastomosis for right-sided obstruction. The single-stage procedure should be the objective for the treatment of patients with obstructing colorectal cancers, except when patients are hemodynamically unstable during surgery or when the condition of the bowel is not optimal for primary anastomosis.
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Affiliation(s)
- Y M Lee
- Department of Surgery, Queen Mary Hospital, University of Hong Kong Medical Centre, Hong Kong
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25
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26
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Law WL, Chu KW, Ho JW, Tung HM, Law SY, Chu KM. Self-expanding metallic stent in the treatment of colonic obstruction caused by advanced malignancies. Dis Colon Rectum 2000; 43:1522-7. [PMID: 11089586 DOI: 10.1007/bf02236731] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The treatment of malignant obstruction of the left colon or rectum usually requires emergency surgery on poor-risk patients, and the creation of a stoma is usually inevitable. With the use of self-expanding metallic stents, the prompt relief of large-bowel obstruction without surgery has become possible. This report describes our results in the use of self-expanding metallic stents in the treatment of left-sided colonic obstruction resulting from advanced malignancies. METHODS From November 1997 to March 1999, insertion of self-expanding metallic stents was attempted in 24 patients with acute left-sided colonic obstruction caused by primary or recurrent malignancies. All the procedures were performed by colorectal surgeons. The guidewire was inserted through the channel of the endoscope, and its position was confirmed with fluoroscopy. Uncovered Wallstent esophageal endoprostheses were used in all except the first case. The insertion and deployment of the stents were under both endoscopic and fluoroscopic guidance. RESULTS There were 24 patients (15 males) with a mean age of 63.6 (range, 36-98) years. Thirteen patients had primary colorectal cancer and 11 had recurrent cancers (colorectal cancer, 5; gastric cancer, 5; other, 1). In the treatment of primary colorectal cancer, seven procedures were palliative, and no subsequent surgery was planned because of extensive liver metastasis or poor medical risk. The other six patients underwent elective resection after mechanical bowel preparation. There was no mortality related to the procedure. Stenting was successful in the relief of obstruction in 23 patients. Perforation of the colon occurred in one patient, and an emergency Hartmann's operation was performed. Migration of the stents occurred in three patients. Only 3 of the 18 patients in the palliation group required the subsequent creation of stomas. CONCLUSION The use of the self-expanding metallic stents can achieve rapid and effective nonsurgical means to relieve left-sided colonic obstruction. It provides good palliation for unresectable advanced tumors that cause colonic obstruction. It may also have a role in the temporary relief of obstruction so that subsequent colonic resection can be performed under elective conditions.
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Affiliation(s)
- W L Law
- Department of Surgery, Queen Mary Hospital, University of Hong Kong Medical Centre, Hong Kong
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27
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Poon RT, Law WL, Chu KW, Wong J. Emergency resection and primary anastomosis for left-sided obstructing colorectal carcinoma in the elderly. Br J Surg 1998; 85:1539-42. [PMID: 9823920 DOI: 10.1046/j.1365-2168.1998.00903.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Emergency colorectal surgery in the elderly has been associated with a high mortality rate. Although the current trend for the management of obstructing left-sided colorectal carcinoma favours primary resection and anastomosis, the safety and benefits of this approach in the elderly have not been studied. METHODS Some 57 elderly (aged more than 70 years) and 59 younger patients underwent emergency resection of an acutely obstructing left-sided colorectal carcinoma. Postoperative results in the two groups were compared. RESULTS The primary resection rate was 95 per cent in the elderly and 89 per cent in younger patients (P = 0.70), with a primary anastomosis rate of 84 per cent and 78 per cent respectively (P = 0.64). Elderly patients had a significantly higher incidence of premorbid risk factors and postoperative cardiorespiratory complications but no increase in surgical complications. Anastomotic leaks occurred in 6 per cent of the elderly and 4 per cent of younger patients (P = 0.65), and the hospital mortality rate was 9 and 5 per cent respectively (P = 0.48). CONCLUSION Emergency resection and primary anastomosis for left-sided obstructing colorectal carcinoma can be performed with favourable outcome in the elderly and should be the treatment of choice in most elderly patients.
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Affiliation(s)
- R T Poon
- Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
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28
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Runkel NS, Hinz U, Lehnert T, Buhr HJ, Herfarth C. Improved outcome after emergency surgery for cancer of the large intestine. Br J Surg 1998; 85:1260-5. [PMID: 9752872 DOI: 10.1046/j.1365-2168.1998.00855.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Emergency surgery for colorectal cancer has become more aggressive and radical over the past decade. This retrospective review analyses the impact on outcome. METHODS The results of emergency surgery within 24 h of admission were compared between 1982 and 1987 (77 patients) and 1988 and 1993 (75 patients). Patient and tumour characteristics were similar in both groups. RESULTS Right colonic obstruction or perforation was treated by primary resection and anastomosis in 11 of 12 patients before 1988 and in all 19 patients thereafter. Primary resection was also the treatment of choice for perforated cancer of the left colon and rectum before 18 of 20) and after (20 of 21) 1988. The rate of primary resection for obstructing cancer of the left colon and rectum increased from 17 of 45 to 30 of 35. One-stage resections for obstructing cancer were performed in ten of 45 and 22 of 35 patients before and after 1988 respectively. The overall mortality rate declined from 14 of 77 to three of 75 after 1988 (P< 0.01). The rate of radical lymphadenectomy rose from six of 46 patients to 42 of 69 after 1988. The 3-year survival rate increased from 50 to 74 per cent (P < 0.05). CONCLUSION The data support further efforts towards improving the immediate and late outcome of emergency surgery in complicated colorectal cancer.
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Affiliation(s)
- N S Runkel
- Department of Surgery, University of Heidelberg, Germany
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29
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Abstract
Colon cancer during pregnancy is uncommon but not rare, with an estimated incidence of several hundred cases per year in the United States. This type of cancer tends to have a poor prognosis that is attributable to delays in diagnosis and advanced disease at diagnosis. The diagnosis frequently is delayed because symptoms of colon cancer, such as rectal bleeding, nausea and vomiting, and constipation, often are attributed to normal pregnancy or minor complications of pregnancy. Pregnancy affects the diagnostic evaluation and therapy of colon cancer because of fetal risks of diagnostic tests and therapy. Appropriate medical evaluation of significant lower gastrointestinal complaints during pregnancy can lead to an earlier and improved diagnosis.
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Affiliation(s)
- M S Cappell
- Department of Medicine, Maimonides Medical Center, Brooklyn, New York, USA
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30
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Savage FJ, Lacombe DL, Hembry RM, Boulos PB. Effect of colonic obstruction on the distribution of matrix metalloproteinases during anastomotic healing. Br J Surg 1998; 85:72-5. [PMID: 9462388 DOI: 10.1046/j.1365-2168.1998.00550.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Anastomotic dehiscence is common after surgery for colonic obstruction. The strength of an anastomosis is dependent on collagen, which is degraded by matrix metalloproteinases (MMPs). The aim of this study was to determine the distribution of the MMPs and their inhibitor, tissue inhibitor of metalloproteinases (TIMP) 1 in an experimental model of colonic obstruction, with and without resection and anastomosis. METHODS The distal colon of rabbits was obstructed with a Silastic ring for 24 h and then either the ring was removed or the obstructed segment was resected and an anastomosis formed. Rabbits were killed immediately or at intervals for up to 7 days after operation. The distribution of the MMPs and TIMP-1 was examined by indirect immunofluorescence. RESULTS MMPs and TIMP-1 were present throughout the descending colon for 24 h in both groups. They persisted to the third day in rabbits with an anastomosis but by day 7 were restricted to the suture line. Their presence correlated with microscopic damage. CONCLUSION The extensive distribution of the MMPs suggests that these enzymes contribute to anastomotic dehiscence, but only in the immediate postoperative period.
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Affiliation(s)
- F J Savage
- Department of Surgery, University College London Medical School, UK
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31
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Forloni B, Reduzzi R, Paludetti A, Colpani L, Cavallari G, Frosali D. Intraoperative colonic lavage in emergency surgical treatment of left-sided colonic obstruction. Dis Colon Rectum 1998; 41:23-7. [PMID: 9510306 DOI: 10.1007/bf02236891] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The study contained herein was undertaken to verify if immediate resection with anastomosis with on-site lavage in emergency treatment of left colon obstruction is a safe alternative to the multistage procedure, to look for solutions to practical problems outlined by previous authors, and to check the hospital stay. METHOD Between 1991 and 1995, all patients (61) admitted with left colon obstruction were treated with intraoperative colonic lavage and primary anastomosis. Personal development of Dudley's technique is reported. Complications and mortality are pointed out. Later, endoscopy was performed to check the status of all survivors. RESULT Low mortality (2 percent) and major complication rates (3 percent) and short hospital stay (11 days, except for patients with major complications) are reported in our series. CONCLUSION One-stage surgery with intraoperative lavage is a safe procedure. Patients have a better quality of life (no stoma occurred) with an effective cost-savings.
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Affiliation(s)
- B Forloni
- 2nd Department of Surgery, Treviglio Hospital, Italy
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