Emergency surgery for obstructive splenic flexure colon cancer: results of a multicentric study of the French Surgical Association (AFC)

2021 ◽  
Author(s):  
Camélia Labiad ◽  
Gilles Manceau ◽  
Diane Mege ◽  
Antoine Cazelles ◽  
Thibault Voron ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Emergency Surgery ◽  
Splenic Flexure ◽  
Multicentric Study

A Tale of Two Colons and Two Cancers

Swiss Surgery ◽  
2003 ◽  
Vol 9 (1) ◽  
pp. 3-7 ◽  
Author(s):  
Gervaz ◽  
Bühler ◽  
Scheiwiller ◽  
Morel
Keyword(s):  
Colorectal Cancer ◽  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Splenic Flexure ◽  
Chromosomal Instability ◽  
Proximal Colon ◽  
Colorectal Carcinogenesis ◽  
Physiological Data ◽  
Central Hypothesis ◽  
Group Stratification

The central hypothesis explored in this paper is that colorectal cancer (CRC) is a heterogeneous disease. The initial clue to this heterogeneity was provided by genetic findings; however, embryological and physiological data had previously been gathered, showing that proximal (in relation to the splenic flexure) and distal parts of the colon represent distinct entities. Molecular biologists have identified two distinct pathways, microsatellite instability (MSI) and chromosomal instability (CIN), which are involved in CRC progression. In summary, there may be not one, but two colons and two types of colorectal carcinogenesis, with distinct clinical outcome. The implications for the clinicians are two-folds; 1) tumors originating from the proximal colon have a better prognosis due to a high percentage of MSI-positive lesions; and 2) location of the neoplasm in reference to the splenic flexure should be documented before group stratification in future trials of adjuvant chemotherapy in patients with stage II and III colon cancer.

Octogenarian Patients with Colon Cancer – Postoperative Morbidity and Mortality are the Major Challenges

2021 ◽  
Author(s):  
Øystein Høydahl ◽  
Tom-Harald Edna ◽  
Athanasios Xanthoulis ◽  
Stian Lydersen ◽  
Birger Henning Endreseth
Keyword(s):  
Colon Cancer ◽  
Survival Rate ◽  
Emergency Surgery ◽  
Relative Survival ◽  
Curative Intent ◽  
Term Survival ◽  
Younger Patients ◽  
Long Term Survival ◽  
Over Time

Abstract Background Few studies have addressed colon cancer surgery outcomes in an unselected cohort of octogenarian patients. The present study aimed to evaluate the relative survival of octogenarian patients after a major resection of colon cancer with a curative intent. Methods All patients diagnosed with colon cancer at Levanger Hospital between 1980 and 2016 were included. We performed logistic regression to test for associations between 100-day mortality and explanatory variables. We performed a relative survival analysis to identify factors associated with short- and long-term survival.Results Among 239 octogenarian patients treated with major resections with curative intent, the 100-day mortality was 10.1%. Among 215 patients that survived the first 100 days, the five-year relative survival rate was 99.7%. The 100-day mortality of octogenarian patients was significantly shorter than that of younger patients, but the long-term survival converged with that of younger patients. Among octogenarian patients, the incidence of colon cancer more than doubled during our 37-year observation period. The relative increase in patients undergoing surgery exceeded the increase in incidence; hence, more patients were selected for surgery over time. A high 100-day mortality was associated with older age, a high American Society of Anaesthesiologists (ASA) score, and emergency surgery. Moreover, worse long-term survival was associated with a high Charlson Comorbidity Index, a high ASA score, a worse TNM stage, emergency surgery and residual tumours. Both the 100‑day and long-term survival rates improved over time. Conclusion Among octogenarian patients with colon cancer that underwent major resections with curative intent, the 100-day mortality was high, but after surviving 100 days, the relative long-term survival rate was comparable to that of younger patients. Further improvements in survival will primarily require measures to reduce the 100-day mortality risk.

scholarly journals Safety of self-expandable metal stents (SEMS) or emergency surgery for acute colonic obstruction in metastatic colon cancer patients treated with bevacizumab

2018 ◽  
Vol 29 ◽  
pp. v97
Author(s):  
V. Pacheco-Barcia ◽  
R. Mondéjar Solís ◽  
O. Martínez Saez ◽  
F. Longo Muñoz ◽  
E. Bermejo ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Cancer Patients ◽  
Emergency Surgery ◽  
Colonic Obstruction ◽  
Metal Stents ◽  
Metastatic Colon Cancer

scholarly journals Laparoscopic left hemicolectomy with regional lymph node navigation and intracorporeal anastomosis for splenic flexure colon cancer

2020 ◽  
Vol 9 (4) ◽  
pp. 170-174
Author(s):  
Yoshiro Itatani ◽  
Kenji Kawada ◽  
Koya Hida ◽  
Yasunori Deguchi ◽  
Nobu Oshima ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Lymph Node ◽  
Splenic Flexure ◽  
Regional Lymph Node ◽  
Intracorporeal Anastomosis ◽  
Left Hemicolectomy

Adjuvant Chemotherapy with Fluorouracil and ccnu in Colon Cancer. Results of a Multicentric Randomized Study

1989 ◽  
Vol 75 (3) ◽  
pp. 269-276 ◽  
Author(s):  
Maurizio Marangolo ◽  
Giuseppe Pezzuoli ◽  
Ettore Marubini ◽  
Dino Amadori ◽  
Patrizia Boracchi ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Randomized Study ◽  
Cure Rate ◽  
Relapse Free Survival ◽  
Multicentric Study ◽  
Free Survival ◽  
Treatment Groups ◽  
Intention To Treat ◽  
Significant Difference

To establish the effectiveness of adjuvant chemotherapy in patients with colon cancer after radical surgery, from 1980 to December 1983, 263 patients were randomized in a multicentric study to no further treatment (131 patients) or to a combination of fluorouracil (5-FU) (400 mg/m2 i.v., days 1–5) and lomustine (CCNU) (100 mg/m2 per os on day 5) every 6 weeks for 9 cycles (132 patients). The two groups were well balanced for age, sex, histology, tumor and nodal extent. Chemotherapy was not given to 30 of the 132 randomized patients, and of 98 treated patients only 38 completed the entire protocol. Analysis, as intention to treat, at 54 months did not show any significant difference between the two treatment groups in terms of relapse-free survival (surgery alone, 74.5%; surgery+adjuvant chemotherapy, 70.9%; p = 0.91). In contrast, a significant difference was observed in overall survival (surgery alone, 78.8%; surgery+adjuvant chemotherapy, 60.8%; p = 0.04). The sites of relapse were identical in the two treatment arms. In conclusion, from this study it appears that adjuvant chemotherapy with 5-FU and CCNU seems to have no efficacy in the cure rate of colon cancer patients.

30-Day Postoperative Morbidity of Emergency Surgery for Obstructive Right- and Left-Sided Colon Cancer in Obese Patients: A Multicenter Cohort Study of the French Surgical Association

2019 ◽  
Vol 37 (2) ◽  
pp. 111-118
Author(s):  
Laurent Genser ◽  
Gilles Manceau ◽  
Diane Mege ◽  
Valérie Bridoux ◽  
Zaher Lakkis ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Emergency Surgery ◽  
Postoperative Morbidity ◽  
Postoperative Mortality ◽  
Hemodynamic Instability ◽  
Normal Weight ◽  
Obese Patients ◽  
Multicenter Cohort Study ◽  
Mortality And Morbidity ◽  
Cardiovascular Comorbidity

Background: Emergency surgery impairs postoperative outcomes in colorectal cancer patients. No study has assessed the relationship between obesity and postoperative results in this setting. Objective: To compare the results of emergency surgery for obstructive colon cancer (OCC) in an obese patient population with those in overweight and normal weight patient groups. Methods: From 2000 to 2015, patients undergoing emergency surgery for OCC in French surgical centers members of the French National Surgical Association were included. Three groups were defined: normal weight (body mass index [BMI] < 25.0 kg/m2), overweight (BMI 25.0–29.9 kg/m2), and obese (BMI ≥30.0 kg/m2). Results: Of 1,241 patients, 329 (26.5%) were overweight and 143 (11.5%) were obese. Obese patients had significantly higher American society of anesthesiologists score, more cardiovascular comorbidity and more hemodynamic instability at presentation. Overall postoperative mortality and morbidity were 8 and 51%, respectively, with no difference between the 3 groups. For obese patients with left-sided OCC, stoma-related complications were significantly increased (8 vs. 5 vs. 15%, p = 0.02). Conclusion: Compared with lower BMI patients, obese patients with OCC had a more severe presentation at admission but similar surgical management. Obesity did not increase 30-day postoperative morbidity except stoma-related complications for those with left-sided OCC.

Laparoscopic resection of transverse colon cancer at splenic flexure: technical aspects and results

2016 ◽  
Vol 68 (1) ◽  
pp. 71-75 ◽  
Author(s):  
Junji Okuda ◽  
Masashi Yamamoto ◽  
Keitaro Tanaka ◽  
Shinsuke Masubuchi ◽  
Kazuhisa Uchiyama
Keyword(s):  
Colon Cancer ◽  
Splenic Flexure ◽  
Transverse Colon ◽  
Laparoscopic Resection ◽  
Transverse Colon Cancer ◽  
Technical Aspects

Outcome comparison between bridge to surgery stenting and emergency surgery in stage II, III obstructive left colon cancer: A multicenter retrospective study.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 747-747
Author(s):  
Han-mo Yoo ◽  
Won-Kyung Kang
Keyword(s):  
Colon Cancer ◽  
Emergency Surgery ◽  
Disease Free Survival ◽  
Left Colon ◽  
Stage Ii ◽  
Stage Iii ◽  
Free Survival ◽  
Sems Group ◽  
Left Colon Cancer ◽  
Disease Free

747 Background: A SEMS (Self Expandable Metallic Stents) has been widely used for obstructive colorectal cancer as a bridge to surgery to avoid emergency surgery. However, it may increase the tumor spillage so that the long-term survival would be compromised. The aim of our study was to compare the short- and long-term outcome of surgery after stent insertion with those of emergency surgery alone for the left colon malignant obstruction patients. Methods: The medical records of patients who received curative resection due to obstructive primary left colon cancer and diagnosed to stage II or III from January 2004 to December 2010 in six hospitals affiliated to the Catholic Medical Center. Overall survival and disease free survival were compared between the SEMS (n = 158) and emergency surgery (n = 56) group. Short-term outcome was also compared. Factors affecting disease-free survival in the SEMS group were analyzed using the cox proportional hazards model. Results: Baseline characteristics were comparable between two groups by pathologic stage. Intra-operative complication (0.0% vs. 7.1%, p = 0.004), re-operation (1.3% vs. 7.1%, p = 0.042), post-operative hospital stay (11.2 ± 6.5 days vs. 14.6 ± 8.9 days, p = 0.010) and conversion rate (3.5% vs. 16.7%, p = 0.028) showed short-term advantages of the SEMS. 5-year DFS in stage II patients was 87.2% for the SMES group, 73.5% for the ES group (p = 0.117). Among stage III patients, 5-year DFS was 55.8% for the SEMS group and 72.0% for the ES group (p = 0.129). 5-year OS of the SEMS group was 90.2%, and of the ES group was 92.4% in stage II patients (p = 0.694). 5-year OS in the SEMS group was 82.8%, and the ES group 73.0% in stage III patients (p = 0.577). For the stage III SEMS patients, hospital of procedure (p = 0.041) and operation date (HR 0.400, 95% C.I 0.176-0.905, p = 0.028) were independent factors on disease free survival. Conclusions: If there’s an intervention team with sufficient experience for the SEMS and a sufficient preparation for emergency surgery, the SEMS is a good therapeutic option for malignant obstruction in left colon cancer.

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