Son Jung Tak, Kim Yong Bog, Kim Hyung Ook, Min Chungki, Park Yongjun, Lee Sung Ryol, Jung Kyung Uk, Kim Hungdai
Department of Surgery, H Plus Yangji Hospital, Seoul, Korea.
Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea.
Ann Coloproctol. 2023 Jun;39(3):260-266. doi: 10.3393/ac.2022.00101.0014. Epub 2022 May 25.
Surgical management of obstructive left colon cancer (OLCC) is still a matter of debate. The classic Hartmann procedure (HP) has a disadvantage that requires a second major operation. Subtotal colectomy/total abdominal colectomy (STC/TC) with ileosigmoid or ileorectal anastomosis is proposed as an alternative procedure to avoid stoma and anastomotic leakage. However, doubts about morbidity and functional outcome and lack of long-term outcomes have made surgeons hesitate to perform this procedure. Therefore, this trial was designed to provide data for morbidity, functional outcomes, and long-term outcomes of STC/TC.
This study retrospectively analyzed consecutive cases of OLCC that were treated by STC/TC between January 2000 and November 2020 at a single tertiary referral center. Perioperative outcomes and long-term outcomes of STC/TC were analyzed.
Twenty-five descending colon cancer (45.5%) and 30 sigmoid colon cancer cases (54.5%) were enrolled in this study. Postoperative complications occurred in 12 patients. The majority complication was postoperative ileus (10 of 12). Anastomotic leakage and perioperative mortality were not observed. At 6 to 12 weeks after the surgery, the median frequency of defecation was twice per day (interquartile range, 1-3 times per day). Eight patients (14.5%) required medication during this period, but only 3 of 8 patients required medication after 1 year. The 3-year disease-free survival was 72.7% and 3-year overall survival was 86.7%.
The risk of anastomotic leakage is low after STC/TC. Functional and long-term outcomes are also acceptable. Therefore, STC/TC for OLCC is a safe, 1-stage procedure that does not require diverting stoma.
梗阻性左半结肠癌（OLCC）的手术治疗仍存在争议。经典的哈特曼手术（HP）有一个缺点，即需要进行二次大手术。提出行结肠次全切除术/全腹结肠切除术（STC/TC）并进行回肠乙状结肠或回肠直肠吻合术作为一种替代手术，以避免造口和吻合口漏。然而，对发病率和功能结局的疑虑以及缺乏长期结局数据，使得外科医生在实施该手术时犹豫不决。因此，本试验旨在提供STC/TC的发病率、功能结局和长期结局的数据。
本研究回顾性分析了2000年1月至2020年11月在一家单一的三级转诊中心接受STC/TC治疗的OLCC连续病例。分析了STC/TC的围手术期结局和长期结局。
本研究纳入了25例降结肠癌（45.5%）和30例乙状结肠癌病例（54.5%）。12例患者发生术后并发症。主要并发症是术后肠梗阻（12例中的10例）。未观察到吻合口漏和围手术期死亡。术后6至12周，排便的中位频率为每天2次（四分位间距，每天1 - 3次）。8例患者（14.5%）在此期间需要药物治疗，但8例患者中只有3例在1年后仍需要药物治疗。3年无病生存率为72.7%，3年总生存率为86.7%。
STC/TC术后吻合口漏的风险较低。功能和长期结局也可以接受。因此，OLCC的STC/TC是一种安全的一期手术，不需要转流造口。
