Reviewing the management of obstructive left colon cancer: Assessing the feasibility of the one-stage resection and anastomosis after intraoperative colonic irrigation

• Published in: Clinical colorectal cancer Vol. 16; no. 2; pp. e89 - e103
• Main Authors: Awotar, Gavish Kumar, Guan, Guoxin, Sun, Wei, Yu, Hongliang, Zhu, Ming, Cui, Xinye, Liu, Jie, Chen, Jiaxi, Yang, Baoshun, Lin, Jiayu, Deng, Zeyong, Luo, Jianwei, Wang, Chen, Nur, Osman Abdhi Fatah, Nivvas, Panjak, Liu, Pixu, Luo, Fuwen
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2017
• Subjects: Aged; Aged, 80 and over; Anastomosis, Surgical - methods; Anastomotic Leak - epidemiology; Colonic lavage; Colonic Neoplasms - diagnosis; Colonic Neoplasms - surgery; Colostomy - methods; Female; Gastroenterology and Hepatology; Hartmann's procedure; Hematology, Oncology and Palliative Medicine; Humans; Intestinal Obstruction - etiology; Intestinal Obstruction - surgery; Intraoperative Care - methods; Laparotomy - methods; Male; Middle Aged; Postoperative Complications - epidemiology; Segmental colectomy; Self-expanding metallic stenting; Therapeutic Irrigation - methods; Trans-anal drainage tube; Statistical Package for the Social Sciences; Transanal Drainage Tube; Conservative group; Node; Hartmann’s Procedure; Colorectal Cancer; HP; Colostomy; Total or Subtotal Colectomy; ASA; Intensive Care Unit; TNM; UICC; ANOVA; AJCC; OLCC; Tumor; Computed Tomography; Familial Adenomatous Polyposis; SPSS; SEMS; Self-expanding metallic stenting; Length of Stay; CON; Union for International Cancer Control; American joint committee on cancer; TDT; TSC; Segmental Colectomy; Colonic lavage; Adenomatosis Polyposis Coli; American Society of Anesthesiologists; Trans-anal drainage tube; ICI; Self-expandable Metallic Stent; CT; HNPCC; LOS; Obstructive Left Colon Cancer; Metastasis classification; Analysis of Variance; APC; FAP; Hereditary Non-polyposis Colorectal Cancer; CRC; ICU; Segmental Resection and Primary Anastomosis with Intraoperative Colonic Irrigation; Segmental colectomy; Trans-anal drainage tube; Hartmann's procedure
• ISSN: 1533-0028; 1938-0674
• DOI: 10.1016/j.clcc.2016.12.001

Abstract Background The management of obstructive left colon cancer (OLCC) remains debatable with single stage procedure of primary colonic anastomosis after cancer resection and on-table intracolonic lavage now being supported. Methods Acute OLCC patients admitted between January 2008 and January 2015 were distributed in five different groups. Group ICI underwent emergency laparotomy for primary anastomosis following colonic resection and intraoperative colonic lavage; Group HP for emergency Hartmann’s Procedure; Group CON for patients treated by conservative management with subsequent elective open cancer resection; Group COL for colostomy patients; Group INT were for patients who had interventional radiology followed by open elective colon cancer resection. The demographics of the patients and co-morbidity, intraoperative data and post-operative data were collected with P<0.05 as significant. Results There were 4 deaths in 138 cases (2.90%). There was only one patient who had anastomotic leakage (5.56%) in Group ICI, compared to none in the Group HP and Group COL, 1 case in Group INT (7.69%) and 2 cases in the Group CON (6.06%) (P>0.05). Group INT and Group CON when compared to the three surgical groups, Groups ICI, Group COL and Group HP individually were statistically significant for the duration of surgery (P<0.05). Conclusions Primary anastomosis following colonic resection after irrigation can be safely performed in selected patients, with the necessary surgical expertise with no increased risk in mortality, anastomotic leakage and other post-operative complications.