Surgical management of obstructive left colon cancer at a national level: Results of a multicentre study of the French Surgical Association in 1500 patients - 02/04/19

Doi : 10.1016/j.jviscsurg.2018.11.008

D. Mege ^a,^{^{1
The first two authors contributed equally to the present work.}} , G. Manceau ^b,^{^{1
The first two authors contributed equally to the present work.}} , V. Bridoux ^c , T. Voron ^d , C. Sabbagh ^e , Z. Lakkis ^f , A. Venara ^g , M. Ouaissi ^h , Q. Denost ⁱ , V. Kepenekian ^j , I. Sielezneff ^a , M. Karoui ^b,^⁎
AFC (French Surgical Association) Working Group^²
Collaborator list from the AFC working group: Tatiana Codjia, Marie Dazza, Guillaume Gagnat, Servane Hamel, Laure Mallet, Paul Martre, Guillaume Philouze, Edouard Roussel, Pauline Tortajada, Anne Stéphanie Dumaine, Bruno Heyd, Brice Paquette, Nicola de’ Angelis, Francesco Esposito, Vincenzo Lizzi, Nicolas Michot, Christophe Tresallet, Oriana Tetard, Elie Fayssal, Maxime Collard, David Moszkowicz, Frederique Peschaud, Jean Charles Etienne, Ludovic loge, Laura Beyer, Thierry Bege, Hélène Corte, 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 H 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.
^a Department of Digestive Surgery, Timone University Hospital, 264, rue Saint-Pierre, 13005 Marseille 05 Provence-Alpes-Côte d’Azur, France
^b Department of Digestive Surgery, Médecine Sorbonne University, Pitié Salpêtrière University Hospital, Assistance publique des hôpitaux de Paris (AP–HP), 43–84, boulevard de l’Hôpital, 75013 Paris, France
^c Department of Digestive Surgery, Charles-Nicolle University Hospital, 37, boulevard Gambetta, 76000 Rouen, Haute Normandie Rouen, France
^d Department of Digestive Surgery, Médecine Sorbonne University, Saint-Antoine University Hospital, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France
^e Department of Digestive Surgery, Amiens University Hospital, 2, place Victor-Pauchet, 80054 Amiens cedex, France
^f Department of Digestive Surgery, Besançon University Hospital, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
^g Department of Digestive Surgery, Angers University Hospital, 4, rue Larrey, 49100 Angers, France
^h Department of Digestive Surgery, Tours University Hospital, 2, allée Gaston-Pages, 37081 Tours, France
ⁱ Department of Digestive Surgery, Haut-Lévèque University Hospital, avenue Magellan, 33600 Pessac, France
^j Department of Digestive Surgery, Lyon Sud University Hospital, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénit, France

^⁎Corresponding author.

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Summary

Purpose

Surgical management of obstructive left colon cancer (OLCC) is controversial. The objective is to report on postoperative and oncological outcomes of the different surgical options in patients operated on for OLCC.

Methods

From 2000–2015, 1500 patients were treated for OLCC in centers members of the French Surgical Association. Colonic stent (n=271), supportive care (n=5), palliative derivation (n=4) were excluded. Among 1220 remaining patients, 456 had primary diverting colostomy (PDC), 329 a segmental colectomy (SC), 246 a Hartmann's procedure (HP) and 189 a subtotal colectomy (STC) as first-stage surgery. Perioperative data and oncological outcomes were compared retrospectively.

Results

There was no difference between the 4 groups regarding gender, age, BMI and comorbidities. Postoperative mortality and morbidity were 4–27% (PDC), 6–47% (SC), 9–55% (HP), 13–60% (STC), respectively (P=0.005). Among the 431 living patients after PDC, 321 (70%) patients had their primary tumour removed. Cumulative mortality and morbidity favoured PDC (7–39%) and SC (6–40%) compared to HP (1–47%) and STC (13–50%) (P=0.04). At the end of follow-up definitive stoma rates were 39% (HP), 24% (PDC), 10% (SC), and 8% (STC) (P<0.0001). Five-year overall and disease-free survival was: SC (67–55%), PDC (54–48%), HP (54–37%) and STC (48–49%). After multivariate analysis, SC and PDC were associated with better prognosis compared to HP and STC.

Conclusion

In OLCC, SC and PDC are the two preferred options in patients with good medical conditions. For patients with severe comorbidities PDC should be recommended, reserving HP and STC for patients with colonic ischaemia or perforation complicating malignant obstruction.

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Keywords : Colon cancer, Obstruction, Surgery, Morbidity, oncological outcomes