Algaby, A., Mohamed, A., Imam, U., Rizk, R. (2024). Efficacy and Safety of Emergency Resection in Treatment of Acutely Obstructing Colonic Cancer. test, 5(3), 285-301. doi: 10.21608/ejmr.2022.129315.1217
Abdulaziz Z. Algaby; Ahmad Salim Mohamed; Usama Saeed Imam; Rimon Boshra Rizk. "Efficacy and Safety of Emergency Resection in Treatment of Acutely Obstructing Colonic Cancer". test, 5, 3, 2024, 285-301. doi: 10.21608/ejmr.2022.129315.1217
Algaby, A., Mohamed, A., Imam, U., Rizk, R. (2024). 'Efficacy and Safety of Emergency Resection in Treatment of Acutely Obstructing Colonic Cancer', test, 5(3), pp. 285-301. doi: 10.21608/ejmr.2022.129315.1217
Algaby, A., Mohamed, A., Imam, U., Rizk, R. Efficacy and Safety of Emergency Resection in Treatment of Acutely Obstructing Colonic Cancer. test, 2024; 5(3): 285-301. doi: 10.21608/ejmr.2022.129315.1217

Efficacy and Safety of Emergency Resection in Treatment of Acutely Obstructing Colonic Cancer

Egyptian Journal of Medical Research
Volume 5, Issue 3, July 2024, Pages 285-301    PDF (349.72 K)
Document Type: Original Article
DOI: 10.21608/ejmr.2022.129315.1217
Authors
Abdulaziz Z. Algaby; Ahmad Salim Mohamed* ; Usama Saeed Imam; Rimon Boshra Rizk
General Surgery Department, Faculty of medicine, Beni-Suef University.
Abstract
Background: Surgical intervention is usually required for patients presenting with bowel obstruction secondary to colon cancer. However, urgent surgical intervention for such cases has higher morbidity and mortality rates. This study was done to evaluate the efficacy and safety of emergency resection in patients with colonic cancer presenting with acute bowel obstruction. Patients and methods: This prospective investigation included 20 patients diagnosed with obstructing colon cancer. For right-sided cases, right or extended right hemicolectomy was performed, followed by a primary anastomosis. Inleft-sidedlesions, resection was done, followed by exteriorization of the two ends.Mortality, morbidity, and length of hospitalization were considered to be indicators of safety, whereas surgical cut margin status and nodal harvesting were the indicators of efficacy. Results: Sigmoid colon was the commonest affected site (50%), followed by descending colon (25%), hepatic flexure (20%), and caecum (5%).Operative time ranged between 90 and 131 minutes, with no intraoperative complications.The included patients were allowed to start oral fluid on the second to the fifth post-operative day. The duration of hospitalization had a mean value of 5.2 days.The number of resected and infiltrated lymph nodes had mean values of 14.65 and 5.7, respectively, with a lymph node ratio ranging between 0.21 and 0.64. No mortality or serious post-operative complications was encountered in the current study. Conclusion: Surgical resection in patients with obstructed cancer colon is associated with safe perioperative and good oncological outcomes.
Keywords
Obstructing colon cancer؛Emergency resection; outcomes
References
  1. Singer MA, Orkin BA. Management of Patients with Acute Large Bowel Obstruction from Colon Cancer. In: Hyman N, Umanskiy K, editors. Difficult Decisions in Colorectal Surgery. Cham: Springer International Publishing; 2017. p. 121-38.
  2. Pisano M, Zorcolo L, Merli C, Cimbanassi S, Poiasina E, Ceresoli M, et al. 2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation. World J Emerg Surg. 2018;13:36.https://doi.org/10.1186/s13017-018-0192-3.
  3. Ibrahim AS, Khaled HM, Mikhail NN, Baraka H, Kamel H. Cancer incidence in egypt: results of the national population-based cancer registry program. J Cancer Epidemiol. 2014;2014:437971.https://doi.org/10.1155/2014/437971.
  4. Metwally IH, Shetiwy M, Elalfy AF, Abouzid A, Saleh SS, Hamdy M. Epidemiology and survival of colon cancer among Egyptians: a retrospective study. J Coloproctol. 2018;38(1):24-9.https://doi.org/10.1016/j.jcol.2017.09.418.
  5. Barnett A, Cedar A, Siddiqui F, Herzig D, Fowlkes E, Thomas CR, Jr. Colorectal cancer emergencies. J Gastrointest Cancer. 2013;44(2):132-42.https://doi.org/10.1007/s12029-012-9468-0.
  6. Melstrom K, Sentovich SM. Colon and Rectal Surgical Emergencies. In: Fong Y, Kauffmann RM, Marcinkowski E, Singh G, Schoellhammer HF, editors. Surgical Emergencies in the Cancer Patient. Cham: Springer International Publishing; 2017. p. 177-87.
  7. Yoo RN, Cho HM, Kye BH. Management of obstructive colon cancer: Current status, obstacles, and future directions. World J Gastrointest Oncol. 2021;13(12):1850-62.https://doi.org/10.4251/wjgo.v13.i12.1850.
  8. Boeding JRE, Ramphal W, Rijken AM, Crolla R, Verhoef C, Gobardhan PD, et al. A Systematic Review Comparing Emergency Resection and Staged Treatment for Curable Obstructing Right-Sided Colon Cancer. Ann Surg Oncol. 2021;28(7):3545-55.https://doi.org/10.1245/s10434-020-09124-y.
  9. Jain SR, Yaow CYL, Ng CH, Neo VSQ, Lim F, Foo FJ, et al. Comparison of colonic stents, stomas and resection for obstructive left colon cancer: a meta-analysis. Tech Coloproctol. 2020;24(11):1121-36.https://doi.org/10.1007/s10151-020-02296-5.
  10. Carraro PG, Segala M, Cesana BM, Tiberio G. Obstructing colonic cancer: failure and survival patterns over a ten-year follow-up after one-stage curative surgery. Dis Colon Rectum. 2001;44(2):243-50.https://doi.org/10.1007/bf02234300.
  11. Gainant A. Emergency management of acute colonic cancer obstruction. J Visc Surg. 2012;149(1):e3-e10.https://doi.org/10.1016/j.jviscsurg.2011.11.003.
  12. El-Din A, El Fol H, Sultan T, Allam W. One-stage versus multiple-stage surgery in the management of left colorectal emergencies. Menoufia Medical Journal. 2018;31(4):1169-74.https://doi.org/10.4103/mmj.mmj_449_17.
  13. Turner J, Liasis L, Malietzis G, Chase A, Reddy ESP. Prognostic Impact of Lymph Node Ratio in Obstructive Colorectal Cancer. J Can Epi Treat. 2017;1(4):8-12.https://doi.org/10.24218/jcet.2017.17.
  14. Alvarez JA, Baldonedo RF, Bear IG, Truán N, Pire G, Alvarez P. Obstructing colorectal carcinoma: outcome and risk factors for morbidity and mortality. Dig Surg. 2005;22(3):174-81.https://doi.org/10.1159/000087436.
  15. Gannavarapu BS, Lau SKM, Carter K, Cannon NA, Gao A, Ahn C, et al. Prevalence and Survival Impact of Pretreatment Cancer-Associated Weight Loss: A Tool for Guiding Early Palliative Care. J Oncol Pract. 2018;14(4):e238-e50.https://doi.org/10.1200/jop.2017.025221.
  16. Phillips RKS, Hittinger R, Fry JS, Fielding LP. Malignant large bowel obstruction. British Journal of Surgery. 1985;72(4):296-302.https://doi.org/10.1002/bjs.1800720417.
  17. Wilson M. Large Bowel Obstruction. In: Brown SR, Hartley JE, Hill J, Scott N, Williams JG, editors. Contemporary Coloproctology. London: Springer London; 2012. p. 573-84.
  18. Biondo S, Gálvez A, Ramírez E, Frago R, Kreisler E. Emergency surgery for obstructing and perforated colon cancer: patterns of recurrence and prognostic factors. Tech Coloproctol. 2019;23(12):1141-61.https://doi.org/10.1007/s10151-019-02110-x.
  19. Cuffy M, Abir F, Audisio RA, Longo WE. Colorectal cancer presenting as surgical emergencies. Surg Oncol. 2004;13(2-3):149-57.https://doi.org/10.1016/j.suronc.2004.08.002.
  20. Arnaud JP, Bergamaschi R. Emergency subtotal/total colectomy with anastomosis for acutely obstructed carcinoma of the left colon. Dis Colon Rectum. 1994;37(7):685-8.https://doi.org/10.1007/bf02054412.
  21. Buechter KJ, Boustany C, Caillouette R, Cohn I, Jr. Surgical management of the acutely obstructed colon. A review of 127 cases. Am J Surg. 1988;156(3 Pt 1):163-8.https://doi.org/10.1016/s0002-9610(88)80056-4.
  22. Lee YM, Law WL, Chu KW, Poon RT. Emergency surgery for obstructing colorectal cancers: a comparison between right-sided and left-sided lesions. J Am Coll Surg. 2001;192(6):719-25.https://doi.org/10.1016/s1072-7515(01)00833-x.
  23. Mege D, Manceau G, Bridoux V, Voron T, Sabbagh C, Lakkis Z, et al. Surgical management of obstructive left colon cancer at a national level: Results of a multicentre study of the French Surgical Association in 1500 patients. J Visc Surg. 2019;156(3):197-208.https://doi.org/10.1016/j.jviscsurg.2018.11.008.
  24. Chang GJ, Kaiser AM, Mills S, Rafferty JF, Buie WD. Practice parameters for the management of colon cancer. Dis Colon Rectum. 2012;55(8):831-43.https://doi.org/10.1097/DCR.0b013e3182567e13.
  25. Ansaloni L, Andersson RE, Bazzoli F, Catena F, Cennamo V, Di Saverio S, et al. Guidelenines in the management of obstructing cancer of the left colon: consensus conference of the world society of emergency surgery (WSES) and peritoneum and surgery (PnS) society. World J Emerg Surg. 2010;5:29.https://doi.org/10.1186/1749-7922-5-29.
  26. Manceau G, Mege D, Bridoux V, Lakkis Z, Venara A, Voron T, et al. Thirty-day mortality after emergency surgery for obstructing colon cancer: survey and dedicated score from the French Surgical Association. Colorectal Dis. 2019;21(7):782-90.https://doi.org/10.1111/codi.14614.
  27. McArdle CS, McMillan DC, Hole DJ. The impact of blood loss, obstruction and perforation on survival in patients undergoing curative resection for colon cancer. Br J Surg. 2006;93(4):483-8.https://doi.org/10.1002/bjs.5269.
  28. Thrumurthy SG, Thrumurthy SS, Gilbert CE, Ross P, Haji A. Colorectal adenocarcinoma: risks, prevention and diagnosis. Bmj. 2016;354:i3590.https://doi.org/10.1136/bmj.i3590.
  29. Chin CC, Wang JY, Yeh CY, Kuo YH, Huang WS, Yeh CH. Metastatic lymph node ratio is a more precise predictor of prognosis than number of lymph node metastases in stage III colon cancer. Int J Colorectal Dis. 2009;24(11):1297-302.https://doi.org/10.1007/s00384-009-0738-7.
  30. Prandi M, Lionetto R, Bini A, Francioni G, Accarpio G, Anfossi A, et al. Prognostic evaluation of stage B colon cancer patients is improved by an adequate lymphadenectomy: results of a secondary analysis of a large scale adjuvant trial. Ann Surg. 2002;235(4):458-63.https://doi.org/10.1097/00000658-200204000-00002.
  31. Lee HY, Choi HJ, Park KJ, Shin JS, Kwon HC, Roh MS, et al. Prognostic significance of metastatic lymph node ratio in node-positive colon carcinoma. Ann Surg Oncol. 2007;14(5):1712-7.https://doi.org/10.1245/s10434-006-9322-3.
  32. Vaccaro CA, Im V, Rossi GL, Quintana GO, Benati ML, Perez de Arenaza D, et al. Lymph node ratio as prognosis factor for colon cancer treated by colorectal surgeons. Dis Colon Rectum. 2009;52(7):1244-50.https://doi.org/10.1007/DCR.0b013e3181a65f0b.
  33. Zare Mirzaei A, Abdorrazaghi F, Lotfi M, Kazemi Nejad B, Shayanfar N. Prognostic Value of Lymph Node Ratio in Comparison to Lymph Node Metastases in Stage III Colon Cancer. Iran J Pathol. 2015;10(2):127-35
  34. Tan KK, Sim R. Surgery for obstructed colorectal malignancy in an Asian population: predictors of morbidity and comparison between left- and right-sided cancers. J Gastrointest Surg. 2010;14(2):295-302.https://doi.org/10.1007/s11605-009-1074-5.
  35. Asgeirsson T, El-Badawi KI, Mahmood A, Barletta J, Luchtefeld M, Senagore AJ. Postoperative ileus: it costs more than you expect. J Am Coll Surg. 2010;210(2):228-31.https://doi.org/10.1016/j.jamcollsurg.2009.09.028.
  36. Chapuis PH, Bokey L, Keshava A, Rickard MJ, Stewart P, Young CJ, et al. Risk factors for prolonged ileus after resection of colorectal cancer: an observational study of 2400 consecutive patients. Ann Surg. 2013;257(5):909-15.https://doi.org/10.1097/SLA.0b013e318268a693.
  37. Kronberg U, Kiran RP, Soliman MS, Hammel JP, Galway U, Coffey JC, et al. A characterization of factors determining postoperative ileus after laparoscopic colectomy enables the generation of a novel predictive score. Ann Surg. 2011;253(1):78-81.https://doi.org/10.1097/SLA.0b013e3181fcb83e.
  38. Biondo S, Jaurrieta E, Jorba R, Moreno P, Farran L, Borobia F, et al. Intraoperative colonic lavage and primary anastomosis in peritonitis and obstruction. Br J Surg. 1997;84(2):222-5
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