Surgery For Left-sided Colon Cancer Research Articles

Colon stenting as a bridge to surgery in obstructive colorectal cancer management.

Colonic stent placement is a commonly used bridging strategy for surgery in patients with obstructive colorectal cancer. The procedure involves the placement of a self-expandable metallic stent (SEMS) across the obstructive lesion to restore intestinal patency and alleviate the symptoms of obstruction. By allowing patients to receive surgery in a planned and staged manner with time for preoperative optimization and bowel preparation, stent placement may reduce the need for emergency surgery, which is associated with higher complication rates and poorer outcomes. This review focuses on the role of colon stenting as a bridge to surgery in the management of obstructive colorectal cancer. SEMS as a bridge to surgery for left-sided colon cancer has been demonstrated to be particularly useful; however, further research is needed for its application in cases of right-sided colon cancer. Colon stent placement also has limitations and potential complications including stent migration, re-obstruction, and perforation. However, the timing of curative surgery after SEMS placement remains inconclusive. Considering the literature to date, performing surgery at an interval of approximately 2 weeks is considered appropriate. Therefore, colonic stent placement may be an effective strategy as a bridge to surgery in patients with obstructive colorectal cancer.

Left-Sided Colon Cancer and Right-Sided Colon Cancer: Are They the Same Cancer or Two Different Entities?

Background Colon cancer is one of the most common cancers in the world and one of the main causes of cancer-related deaths. In Morocco, it occupies the first place among digestive cancers. Right-sided and left-sided colon cancers have different embryological, epidemiological, pathological, genetic, and clinical characteristics. This distinction leads to differences in the evolution and prognosis of the disease. This study aimed to identify epidemiological factors and clinical and pathological characteristics that can influence perioperative and prognostic outcomes in patients with right-sided colon cancer compared to those with left-sided colon cancer. Methodology We conducted a retrospective cohortstudy over a period of nine years from January 2012 until December 2020. We included 277 patients divided into two groups, namely, right colon cancer (group 1) (n = 99) and left colon cancer (group 2) (n = 178). Results The average age of our series was 57.4 years, with extremes ranging from 19 to 89 years old (SD = ±13.6451 years). The average age in the right colon group was 55.97 (SD = ±13.341 years). The average age in the left colon group was 58.18 (SD = ±13.69 years). The male gender had a predominance, with a sex ratio of 1.3 for both groups. Among the patients in group 2, 65% showed lymph node involvement on the CT scan, whereas only 34% of patients in group 1 displayed the same condition. The recurrence rate in the right-sided colon cancer group was 22.2% compared to 24.9% in the left-sided group. The five-year overall survival was estimated for the right-sided and left-sided colon cancer groups at 87% and 96.5%, respectively. In patients with stage III and IV cancer, overall survival was better for those who underwent surgery for left-sided colon cancer compared to those who underwent surgery for right-sided colon cancer (p = 0.029). In the case of vascular emboli or involvement of the perineural sheath, there was no significant difference in overall survival (p = 0.446 and p = 0.655, respectively). The three-month survival without recurrence was almost identical in both groups (31% for right-sided colon cancers and 30.9% for left-sided colon cancers). Age over 61 years was a predictive factor of poor prognosis in recurrence-free survival (hazard ratio = 3.245; p = 0.023). Conclusions We identified factors that can influence perioperative outcomes and prognosis in patients with right-sided colon cancer compared to those with left-sided colon cancer. Our findings suggest that age and lymph node involvement along with other factors play a role in the overall survival and recurrence outcomes of these patients. Further research is necessary to explore these differences and develop personalized treatment plans for patients with colon cancer.

Short-term outcomes of extracorporeal colo-colonic triangular anastomosis versus functional end-to-end anastomosis in laparoscopic-assisted surgery for left-sided colon cancer: a propensity score matching analysis.

To the best of our knowledge, no studies have compared the short-term outcomes between colo-colonic extracorporeal triangular anastomosis (TA) and functional end-to-end anastomosis (FEEA), with a focus on laparoscopic-assisted surgery for left-sided colon cancer. Therefore, this study compared the short-term outcomes of these anastomoses using propensity score matching analysis. This retrospective study included 129 patients with stage I-IV left-sided colon cancer who underwent laparoscopic-assisted surgery with colo-colonic extracorporeal TA (n = 75) or FEEA (n = 54) between May 2009 and March 2021. After propensity score matching, 84 patients (TA, n = 42; FEEA, n = 42) were included in the analysis. The primary endpoint was the complication rate for all grades, and the secondary endpoints were the rates of Clavien - Dindo grade ≥ 3 complications and anastomotic leakage. In the matched cohort, there were no significant differences in the complication rates for all grades (35.7% vs. 26.2%, p = 0.479), Clavien - Dindo grade ≥ 3 complications (11.9% vs. 11.9%, p = 1), and anastomotic leakage (0% vs. 4.8%, p = 0.494) between the TA and FEEA groups. In the univariate logistic regression analysis, TA did not increase the frequency of complications for any grades compared with FEEA (odds ratio: 1.570, 95% confidence interval: 0.616-3.980, p = 0.347). Extracorporeal TA demonstrated equivalent short-term outcomes compared with FEEA in cases of laparoscopic-assisted surgery for left-sided colon cancer. TA can be an alternative anastomosis technique in cases wherein FEEA is difficult to perform.

P-266 Oncological outcomes of self-expanding metal stent as a bridge to surgery for obstructive left-sided colon cancer

Self-expandable metallic stents (SEMS) are used as a bridge to surgery in patients with obstructive colon cancer. However, outcomes associated with stent-related perforation and the optimal timing from stenting to elective surgery remain unknown, and there are still concerns on the oncological safety. The aim of our study was to assess the long-term oncological outcomes as well as surgical morbidity of patients treated with SEMS for left-sided obstructive colon cancer as a bridge to surgery. A prospective database of patients who underwent SEMS placement between 2005 and 2019 was retrospectively reviewed. A subgroup of stage I-III SEMS patients were matched for sex, age, ASA, and oncological stage with patients (ratio 1:2) who underwent elective surgery for left-sided colon cancer operated on with curative intention. Patient demographics, tumor characteristics, stoma formation, morbidity, and oncological outcomes were analyzed. A total of 45 SEMS patients were included, and matched with 90 patients who underwent elective surgery of left-sided colon cancer. Both groups were comparable with respect to age, sex, ASA, BMI, preoperative albumin, and pathological stage. The median time from SEMS to surgery was 12.3 +/- 6.5 days (4-36). There were no statistically significant differences between the SEMS group and the elective group regarding the following: laparoscopic approach (71.7 % vs 77.8%, p=0.4), anastomotic leakage rate (6.7% vs 3.3%, p=0.4), postoperative hospital stay (mean 11.6 vs 9.8 days, p=0.36), overall morbidity according the Clavien-Dindo classification (p=0.85) perforation rate on pathological examination (6.7% vs 4.4%, p=0.69), and adjuvant chemotherapy (66.7% vs 64.4%, p=0.85). A temporary protective ileostomy was performed in three patients in the SEMS group, while none of the elective group had a stoma (6.7% vs 0.0%, P=0.035). There were no statistically significant differences between groups regarding overall survival (Log Rank = 0.075) and the 3-and 5-year disease-free survival. In our experience, the use of SEMS as a bridge to surgery is a safe option with long-term oncological outcomes similar to non-oclusive colon cancer elective surgery. Timing of surgery after stent placement represents probably a crucial step and should be further investigated.

Comparison of clinical outcomes between laparoscopic and open surgery for left-sided colon cancer: a nationwide population-based study

The role of laparoscopic surgery for left-sided colon cancer has been supported by the results of randomized controlled trials. However, its benefits and disadvantages in the real world setting should be further assessed with population-based studies.The hospitalization data of patients undergoing open or laparoscopic surgery for left-sided colon cancer were sourced from the Taiwan National Health Insurance Research Database. Patient and hospital characteristics and perioperative outcomes including length of hospital stay, operation time, opioid use, blood transfusion, intensive care unit (ICU) admission, and use of mechanical ventilation were compared. The overall survival was also assessed. Patients undergoing laparoscopic surgery had shorter hospital stay (p < 0.0001) and less demand for opioid analgesia (p = 0.0005). Further logistic regression revealed that patients undergoing open surgery were 1.70, 2.89, and 3.00 times more likely to have blood transfusion, to be admitted to ICU, and to use mechanical ventilation than patients undergoing laparoscopic surgery. Operations performed in medical centers were also associated with less adverse events. The overall survival was comparable between the 2 groups.With adequate hospital quality and volume, laparoscopic surgery for left-sided colon cancer was associated with improved perioperative outcomes. The long-term survival was not compromised.

High vascular ligation in left-sided colon cancer surgery is safe and adequate

We aimed to evaluate the safety and adequacy of high vascular ligation in surgery for left-sided colon cancer. Between 2007 and 2016, hand-assisted laparoscopic surgery was performed on 228 patients for descending or sigmoid colon cancer with high ligation of the inferior mesenteric artery and vein. We collected and prospectively studied demographic, clinical, and long-term outcome results. Complications were assessed with the Clavien–Dindo classification. The 5‑year survival (OS) and 5‑year disease-free survival (DFS) probability rates were calculated using Kaplan–Meier curves. There were 71 (31%) patients with stage I disease, 67 (29.7%) with stage II, 65 (28.4%) with stage III, and 25 (10.9%) with stage IV. The average harvested lymph node count was 16.5 ± 10 (range, 10–90). Length of postoperative hospital stay was 6.3 ± 3.2 days (range, 1–30). Eleven (4.82%) patients had complications, and three of them (1.3%) were re-operated. There was no anastomotic leakage detected in our group of patients. The five-year OS of all stages using Kaplan–Meier curves was 0.75 and the DFS was 0.8. Our data support the opinion that high vascular ligation while performing surgery for left-sided colon cancer is safe. Long-term oncological outcomes were similar to those presented in other studies.

THE RATIONALE OF HIGH VASCULAR LIGATION IN SURGERY FOR LEFT SIDED COLON CANCER

Background. The aim of the study was to evaluate the safety and adequacy of high vascular ligation while performing surgery for left-sided colon cancer. We performed a retrospective analysis of prospectively collected data of patients operated laparoscopically for sigmoid or descending colon cancer in a single tertiary care institution over a period of 10 years. Patients and methods. Between January 2007 and December 2016 hand-assisted laparoscopic surgery (HALS) was performed on 228 patients due to invasive and histologically verified descending or sigmoid colon cancer with high ligation of inferior mesenteric artery and vein. Patients who had carcinoma in situ were excluded. The following variables were collected and prospectively studied: age, sex, cancer localization, cancer stage, type of surgery, operative time, lymph node harvest, intraoperative complications, conversions, duration of hospital and postoperative stay, postoperative complications occurring within 30 days. Complications were assessed by Clavien- Dindo classification. Results. Patient mean age was 64±10 years (range, 40 - 86). There were 112 females (49.1 %) and 116 males (50.9 %). A total of 149 (65.5 %) sigmoid colectomies and 79 (34.5 %) left hemicolectomies have been performed. There were total of 71 (31 %) patients with stage I disease, 67 (29.7 %) – stage II, 65 (28.4 %) stage III and 25 (10.9 %) stage IV. Aerage operative time was 105±39 minutes (range, 45-270). Average harvested lymph node count was 16.5±10 (range, 10 - 90). Length of postoperative stay was 6.3±3.2 days (range, 1-30). Eleven (4.82 %) patients had complications, three of them (1,3%) were reoperated. There was no anastomotic leakage detected in this group of patients. Conclusions. Our data support the opinion, that high vascular ligation while performing surgery for left sided colon cancer is safe. Recorded lymphnode harvest confirms oncological adequacy of such an approach.

Laparoscopic surgery for left-sided colon cancer: Clinical and long-term oncologic outcomes

Purpose Laparoscopic surgery for left-sided colon cancer is one of the most frequent procedures performed in laparoscopic colorectal surgery. In this study, we analyzed clinical and long-term oncological outcomes of left-sided colon cancer patients who underwent conventional laparoscopic surgery (CLS) and hand-assisted laparoscopic surgery (HALS). Methods A total of 172 CLS patients and 72 HALS patients for left-sided colon cancer from July 2001 to December 2011 were included in this study. The collected data included the clinical and oncological outcomes. We analyzed overall survival and disease-free survival by tumor, node, metastasis (TNM) stage. Results The mean age of the patients was 64 years, and male patients were predominant. The mean follow-up period was 58.1 months. The number of patients that belong in each TNM stage 0, I, II, III, and IV was as follows: 17 (7%), 47 (19.2%), 70 (28.7%), 80 (32.8%), and 30 (12.3%), respectively. Overall 5-year survival rate for TNM stage I, II, III, and IV was 87.1%, 82.8%, 82%, and 12%, respectively. Overall 5-year survival rate for CLS group and HALS group was 90.2% and 66.7%, 86.5% and 77%, 88.7% and 67.4%, and 18.9% and 0%, respectively. Disease-free 5-year survival rate for TNM stage I, II, and III was 97.7%, 90.7%, and 72.8%, respectively. Disease-free 5-year survival rate for CLS group and HALS group was 97.3% and 100%, 100% and 78.8%, and 81% and 55.1%, respectively. Conclusion These data show the feasibility and safety of laparoscopic surgery for left-sided colon cancer in terms of long-term oncological outcomes. Keywords: Left-sided colon cancer, Conventional laparoscopic surgery, Hand-assisted laparoscopic surgery, Disease-free survival, Overall survival

Reduced-port robotic anterior resection for left-sided colon cancer using the Da Vinci single-site(®) platform.

Single-Site(®) port plus one conventional robotic port, a reduced-port robotic surgery (RPRS) for left-sided colorectal cancer, can enable lymphovascular dissection using the Endowrist(®) function; this allows safe rectal transection through an additional port and maintains the cosmetic advantage of single-incision laparoscopic surgery. Between August 2014 and December 2014, the study group included 11 patients who underwent a RPRS for left-sided colon cancer. There was one (9.1%) case of descending colon cancer, six (54.5%) cases of sigmoid colon cancer, and four (36.4%) cases of rectosigmoid colon cancer. The mean total operation time and docking time were 289±77 and 17±7 min. The mean times to soft diet and possible length of stay were 5.6±0.8 and 7.4±0.7 days. The mean total number of lymph nodes harvested was 18.7±7.9. The mean proximal and distal resection margins were 7.8±4.7 and 4.7±2.4 cm. Reduced-port robotic surgery for left-sided colon cancer using the Single-Site(®) system appears to be feasible and safe using the new robotic single-access platform. Copyright © 2015 John Wiley & Sons, Ltd.

Factors affecting difficulty of laparoscopic surgery for left-sided colon cancer

Laparoscopic colon resection for left-sided colon cancer is being performed with increasing frequency worldwide. The purpose of this study is to evaluate the influence of patient- and procedure-related factors on difficulty of laparoscopic surgery for left-sided colon cancer. Two hundred sixty consecutive patients underwent laparoscopic surgery for left-sided colon cancer from July 2005 to December 2008. Gender, body mass index (BMI), tumor location, tumor size, previous abdominal surgery, tumor depth, tumor stage, splenic flexure mobilization, type of anastomosis, and site of arterial division were analyzed as potential variables that affect difficulty of laparoscopic surgery. Dependent variables were operative time, intraoperative blood loss, intra- and postoperative complications, and proximal and distal tumor margin. Univariate and multivariate analyses were performed to determine predictive significance of variables. Multivariate analysis showed that male gender (P = 0.0183) and splenic flexure mobilization (P < 0.0001) were independently predictive of longer operative time. Splenic flexure mobilization was related to greater intraoperative blood loss (P = 0.0006), intraoperative complications (P = 0.0111, odds ratio: 7.22), and wider distal tumor margin (P = 0.0048). Male gender and splenic flexure mobilization were independent predictors of difficulty of laparoscopic surgery for left-sided colon cancer. In contrast, our findings also showed that BMI, tumor location, previous abdominal surgery, tumor stage, type of anastomosis, and site of arterial division did not have an adverse impact on difficulty of laparoscopic surgery for left-sided colon cancer in our clinical setting. Our data support the safety of performing laparoscopic surgery for left-sided colon cancer in well-selected patients by well-experienced surgical teams.

Incidence of synchronous appendiceal neoplasm in patients with colorectal cancer and its clinical significance

BackgroundThe aims of this study were to evaluate the incidence of synchronous appendiceal neoplasm in patients with colorectal cancer, and to determine its clinical significance.MethodsPathological reports and medical records were reviewed of patients with colorectal adenocarcinoma who underwent oncological resection of the tumor together with appendectomy at the Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand between September 2000 and April 2008.ResultsThis study included 293 patients with an average age of 62 years (range 19–95) and 51 percent were male. Of the patients studied, 228 (78 percent) had right hemicolectomy, whereas the others (22 percent) had surgery for left-sided colon cancer or rectal cancer. One patient (0.3 percent) had epithelial appendiceal neoplasm (mucinous cystadenoma) and 3 patients (1.0 percent) had metastatic colorectal cancer in the mesoappendix. However, the presence of synchronous appendiceal tumors and/or metastasis did not alter postoperative management, as these patients had received adjuvant therapy and were scheduled for surveillance program because of nodal involvement.ConclusionThe incidence of synchronous primary appendiceal neoplasm and secondary (metastatic) appendiceal neoplasm in colorectal cancer patients was 0.3 and 1.0 percent, respectively. However, these findings did not change the postoperative clinical management.