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Obstructive Left Colon Cancer Should Be Managed by Using a Subtotal Colectomy Instead of Colonic Stenting

대한대장항문학회지 2016년 32권 6호 p.215 ~ 220
 ( Min Chung-Ki ) - Sungkyunkwan University School of Medicine Kangbuk Samsung Hospital Department of Surgery

 ( Kim Hyung-Ook ) - Sungkyunkwan University School of Medicine Kangbuk Samsung Hospital Department of Surgery
 ( Lee Dong-Hyoun ) - Sungkyunkwan University School of Medicine Kangbuk Samsung Hospital Department of Surgery
 ( Jung Kyung-Uk ) - Sungkyunkwan University School of Medicine Kangbuk Samsung Hospital Department of Surgery
 ( Lee Sung-Ryol ) - Sungkyunkwan University School of Medicine Kangbuk Samsung Hospital Department of Surgery
 ( Kim Hung-Dai ) - Sungkyunkwan University School of Medicine Kangbuk Samsung Hospital Department of Surgery
 ( Chun Ho-Kyung ) - Sungkyunkwan University School of Medicine Kangbuk Samsung Hospital Department of Surgery

Abstract


Purpose: This study compared a subtotal colectomy to self-expandable metallic stent (SEMS) insertion as a bridge to surgery for patients with left colon-cancer obstruction.

Methods: Ninety-four consecutive patients with left colon-cancer obstruction underwent an emergency subtotal colectomy or elective SEMS insertion between January 2007 and August 2014. Using prospectively collected data, we performed a retrospective comparative analysis on an intention-to-treat basis.

Results: A subtotal colectomy and SEMS insertion were attempted in 24 and 70 patients, respectively. SEMS insertion technically failed in 5 patients (7.1%). The mean age and rate of obstruction in the descending colon were higher in the subtotal colectomy group than the SEMS group. Sex, underlying disease, American Society of Anesthesiologists physical status, and pathological stage showed no statistical difference. Laparoscopic surgery was performed more frequently in patients in the SEMS group (62 of 70, 88.6%) than in patients in the subtotal colectomy group (4 of 24, 16.7%). The overall rate of postoperative morbidity was higher in the SEMS group. No Clavien-Dindo grade III or IV complications occurred in the subtotal colectomy group, but 2 patients (2.9%) died from septic complications in the SEMS group. One patient (4.2%) in the subtotal colectomy group had synchronous cancer. The total hospital stay was shorter in the subtotal colectomy group. The median number of bowel movements in the subtotal colectomy group was twice per day at postoperative 3?6 months.

Conclusion: A subtotal colectomy for patients with obstructive left-colon cancer is a clinically and oncologically safer, 1-stage, surgical strategy compared to SEMS insertion as a bridge to surgery.

키워드

Intestinal obstruction; Colon neoplasms; Colectomy; Self-expandable metallic stents
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