Comparison of two‐stage and three‐stage surgery for obstructing left‐sided colon cancer. Issue 6 (31st March 2022)

• Record Type: Journal Article
• Authors: Lin, Yu‐Zu; Cheng, Hou‐Hsuan; Huang, Sheng‐Chieh; Chang, Shih‐Ching; Lan, Yuan‐Tzu
• Is Part Of: ANZ journal of surgery. Volume 92:Issue 6(2022)
• Page Start: 1466
• Page End: 1471
• Publication Date: 2022-03-31
• Subjects: colon cancer -- intestinal obstruction -- surgical stomas; Surgery -- Periodicals; 617.005
• DOI: 10.1111/ans.17639
• Languages: English
• ISSNs: 1445-1433

Abstract

Abstract: Background: Whether the timing of stoma reversal after emergency diversion for obstructive left‐sided colon cancer affects patient outcomes is unknown. Our study compared the short‐ and long‐term outcomes of two‐ and three‐stage operations for obstructive left‐sided colon cancer. Methods: Patients with obstructive left‐sided colon cancer who underwent staged resection at a referral hospital between January 2002 and December 2015 were retrospectively identified. Patient demographics and outcomes were analysed and compared between the two groups. Statistical significance was set as p < 0.05. Results: A total of 191 patients were reviewed. The overall complication rate was higher for two‐stage surgery than for three‐stage surgery (57.1% versus 36.0%, p < 0.01). Surgical site infection and/or wound dehiscence were the most common complications. Other complications, including anastomotic leakage, ileus, and bowel obstruction, were not significantly different between the two groups. The five‐year overall survival and disease‐free survival in stage II and III patients were comparable. Conclusion: Among patients with obstructive left‐sided colon cancer who underwent staged resection, two‐stage surgery was associated with a higher complication rate, especially for surgical site infection and/or wound dehiscence, which could be managed by local treatment. The timing of stoma reversal was not associated with survival differences in patients with stage II and III disease. However, issues such as the location of the tumour and diverting stoma, along with the need to resect other upper abdominal organs, should all be considered when deciding between two‐ and three‐stage surgeries. Abstract : A decompressing stoma can be constructed as bridge to elective surgery in left‐sided obstructive colon cancer. Simultaneous tumour resection and stoma reversal carries a higher rate of wound complication compared with tumour resection followed by stoma reversal in separate surgeries. However, issues such as the location of the tumour and diverting stoma, along with the need to resect other upper abdominal organs, should all be considered when deciding the stages of operation.