Surgical management of obstructive right-sided colon cancer at a national level results of a multicenter study of the French Surgical Association in 776 patients
Diane Mege, Gilles Manceau, Laura Beyer-Berjot, Valérie Bridoux, Zaher Lakkis, Aurélien Venara, Thibault Voron, Francesco Brunetti, Igor Sielezneff, Mehdi Karoui, AFC (French Surgical Association) Working Group, Anne Berger, Mehdi Ouaissi, Tatiana Codjia, Marie Dazza, Guillaume Gagnat, Servane Hamel, Laure Mallet, Paul Martre, Guillaume Philouze, Edouard Roussel, Pauline Tortajada, Anne Stéphanie Dumaine, Bruno Heyd, Zaher Lakkis, Brice Paquette, Nicola De' Angelis, Francesco Esposito, Vincenzo Lizzi, Nicolas Michot, Quentin Denost, Christophe Tresallet, Oriana Tetard, Charles Sabbagh, Pauline Rivier, Elie Fayssal, Maxime Collard, David Moszkowicz, Frederique Peschaud, Jean Charles Etienne, Ludovic Loge, Laura Beyer-Berjot, Thierry Bege, Hélène Corte, Julien Bonnet, Elsa D'Annunzio, Marine Humeau, Julien Issard, Nicolas Munoz, Julio Abba, Yaqoub Jafar, Laurence Lacaze, Pierre Yves Sage, Lilija Susoko, Bertrand Trilling, Catherine Arvieux, François Mauvais, Béatrice Ulloa Severino, Sophie Pitel, Arthus Vauchaussade de Chaumont, Bogdan Badic, Benjamin Blanc, Marine Bert, Paul Rat, Pablo Ortega-Deballon, Amélie Chau, Clémentine Dejeante, Christophe Mariette, Guillaume Piessen, Emilie Grégoire, Abdallah Alfarai, Jérémie Lefèvre, Magali Cabau, Anaelle David, Deborah Kadoche, Fanny Dufour, Géraldine Goin, Yvain Goudard, Ghislain Pauleau, Philippe Sockeel, Bruno De la Villeon, Karine Pautrat, Clarisse Eveno, Antoine Brouquet, Anne Cécile Couchard, Gregoire Balbo, Jean Yves Mabrut, Justine Bellinger, Martin Bertrand, Aurélie Aumont, Emilie Duchalais, Anne-Sophie Messière Adrien Tranchart, Jean-Baptiste Cazauran, Virginie Pichot-Delahaye, Vincent Dubuisson, Leon Maggiori, Bilem Djawad Boumediene, David Fuks, Xavier Kahn, Eve Huart, Jean Marc Catheline, Grégory Lailler, Oussama Baraket, Patrick Baque, Jean Marie Diaz de Cerio, Philippe Mariol Bernard Maes, Philippe Fernoux, Philippe Guillem, Eric Chatelain, Charlotte de Saint Roman, Kévin Fixot, Diane Mege, Gilles Manceau, Laura Beyer-Berjot, Valérie Bridoux, Zaher Lakkis, Aurélien Venara, Thibault Voron, Francesco Brunetti, Igor Sielezneff, Mehdi Karoui, AFC (French Surgical Association) Working Group, Anne Berger, Mehdi Ouaissi, Tatiana Codjia, Marie Dazza, Guillaume Gagnat, Servane Hamel, Laure Mallet, Paul Martre, Guillaume Philouze, Edouard Roussel, Pauline Tortajada, Anne Stéphanie Dumaine, Bruno Heyd, Zaher Lakkis, Brice Paquette, Nicola De' Angelis, Francesco Esposito, Vincenzo Lizzi, Nicolas Michot, Quentin Denost, Christophe Tresallet, Oriana Tetard, Charles Sabbagh, Pauline Rivier, Elie Fayssal, Maxime Collard, David Moszkowicz, Frederique Peschaud, Jean Charles Etienne, Ludovic Loge, Laura Beyer-Berjot, Thierry Bege, Hélène Corte, Julien Bonnet, Elsa D'Annunzio, Marine Humeau, Julien Issard, Nicolas Munoz, Julio Abba, Yaqoub Jafar, Laurence Lacaze, Pierre Yves Sage, Lilija Susoko, Bertrand Trilling, Catherine Arvieux, François Mauvais, Béatrice Ulloa Severino, Sophie Pitel, Arthus Vauchaussade de Chaumont, Bogdan Badic, Benjamin Blanc, Marine Bert, Paul Rat, Pablo Ortega-Deballon, Amélie Chau, Clémentine Dejeante, Christophe Mariette, Guillaume Piessen, Emilie Grégoire, Abdallah Alfarai, Jérémie Lefèvre, Magali Cabau, Anaelle David, Deborah Kadoche, Fanny Dufour, Géraldine Goin, Yvain Goudard, Ghislain Pauleau, Philippe Sockeel, Bruno De la Villeon, Karine Pautrat, Clarisse Eveno, Antoine Brouquet, Anne Cécile Couchard, Gregoire Balbo, Jean Yves Mabrut, Justine Bellinger, Martin Bertrand, Aurélie Aumont, Emilie Duchalais, Anne-Sophie Messière Adrien Tranchart, Jean-Baptiste Cazauran, Virginie Pichot-Delahaye, Vincent Dubuisson, Leon Maggiori, Bilem Djawad Boumediene, David Fuks, Xavier Kahn, Eve Huart, Jean Marc Catheline, Grégory Lailler, Oussama Baraket, Patrick Baque, Jean Marie Diaz de Cerio, Philippe Mariol Bernard Maes, Philippe Fernoux, Philippe Guillem, Eric Chatelain, Charlotte de Saint Roman, Kévin Fixot
Abstract
Aim: To report the results of surgery for obstructive right colon cancer (ORCC) and to identify risk factors associated with worse outcomes that may help surgeons to choose the best surgical option.
Methods: This is a retrospective national cohort study, including all patients operated on for ORCC from 2000 to 2015. Those treated with colonic stent or symptomatic treatment were excluded. We described outcomes after surgery for ORCC and performed multivariate analyses for mortality, morbidity and survival.
Results: Among 776 patients analyzed, 716 (92%) had their primary tumor removed, with primary anastomosis in 582 (82%). The remaining 194 underwent anastomosis with loop ileostomy (n = 21), resection with double-end stoma (n = 113), defunctioning stoma without resection (n = 48) and ileocolic by-pass (n = 12). Postoperative mortality, morbidity and anastomotic leak rates were 10%, 51% and 14%, respectively. In multivariate analysis, age >70, ASA score ≥3 and hemodynamic instability were predictors of postoperative mortality whereas ASA score ≥3, hemodynamic instability and intra-operative complications were predictors of severe morbidity. No factors were correlated with anastomotic leak. After a median follow-up of 26 months, 8% of patients were alive with a permanent stoma. Five-year overall, disease-free and cancer-specific survival was 42%, 42% and 62%, respectively. In multivariate analysis, peritonitis, synchronous metastases and absence of adjuvant chemotherapy were predictors of decreased overall survival.
Conclusions: Emergency surgery for ORCC is associated with high mortality and morbidity. Two third of patients with ORCC can be managed with resection and primary anastomosis. For high-risk patients, a staged surgical management may be discussed.
Keywords: Colonic obstruction; Emergency surgery; National database; Right colonic cancer.
Copyright © 2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
Source: PubMed