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01-02-2022 | Enterostomy | Original Article

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

Authors: Camélia Labiad, Gilles Manceau, Diane Mege, Antoine Cazelles, Thibault Voron, Valérie Bridoux, Zaher Lakkis, Solafah Abdalla, Mehdi Karoui, AFC (French Surgical Association) Working Group

Published in: Updates in Surgery | Issue 1/2022

Abstract

Management of malignant left-sided colonic obstruction remains challenging and requires a stoma in 40–65% of patients. In those with obstructive splenic flexure colon cancer (OSFCC), a debate still exists regarding the most appropriate surgery. The aim of this muticenter study was to report and compare the different surgical procedures in OSFCC patients with a special focus on operative and histological characteristics and survival outcomes including 12-month stoma-free survival. Between 2000 and 2015, 2325 patients were treated for obstructive colon cancer in centers members of the French National Surgical Association (AFC). Among them, 198 underwent surgery for OSFCC and were retrospectively analyzed. Patients with OSFCC and proximal colonic ischemia or perforation were excluded. Four procedures were performed: decompressing stoma (DS, 39%), splenic flexure colectomy (SFC, 39%), subtotal colectomy (STC, 17%,) and left hemicolectomy (LHC, 5%). All patients treated with LHC underwent a Hartmann’s procedure. There was no significant difference between groups for postoperative mortality and morbidity. Hospital stay was significantly longer after DS. The length of the specimen, longitudinal resection margins and number of harvested lymph nodes were significantly higher in the STC group. There was no difference for overall and disease-free survival. Stoma-free survival was significantly lower after LHC (62%) in comparison with the other groups (p < 0.0001). At the end of follow-up, 50% of patients who underwent LHC had a permanent stoma. In OSFCC patients without proximal colonic ischemia or peritonitis, LHC should no longer be recommended due to a high risk of permanent stoma.

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Title: Emergency surgery for obstructive splenic flexure colon cancer: results of a multicentric study of the French Surgical Association (AFC)
Authors: Camélia Labiad
Gilles Manceau
Diane Mege
Antoine Cazelles
Thibault Voron
Valérie Bridoux
Zaher Lakkis
Solafah Abdalla
Mehdi Karoui
AFC (French Surgical Association) Working Group
Publication date: 01-02-2022
Publisher: Springer International Publishing
Keywords: Enterostomy
Colectomy
Subtotal Colectomy
Colectomy
Enterostomy
Subtotal Colectomy
Hemicolectomy
Hemicolectomy
Colon Cancer
Colon Cancer
Published in: Updates in Surgery / Issue 1/2022
Print ISSN: 2038-131X
Electronic ISSN: 2038-3312
DOI: https://doi.org/10.1007/s13304-021-01206-0

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

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