Obstructive left side colon cancer: time for a tailored operative approach?

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Gastroenterology

Background:

• Colorectal cancer (CRC) obstruction presents frequent clinical challenges.
• Optimal surgical management strategies for obstructive CRC remain debated.
• This study evaluates outcomes of different operative approaches for CRC obstruction.

Purpose of the Study:

• To compare operative approaches for colorectal cancer obstruction.
• To evaluate quality of life and oncologic safety outcomes.
• To guide treatment indications based on patient stability and intent.

Main Methods:

• Retrospective analysis of 108 patients (Jan 2014 - Dec 2019).
• Four groups: Hartmann's procedure (PH), primary anastomosis (PA), deviating stoma (SD), self-expanding metallic stent (SS).
• Endpoints: quality of life, oncologic safety, survival rates.

Main Results:

• Primary anastomosis (PA) showed superior overall and disease-free survival compared to Hartmann's procedure (PH).
• Self-expanding metallic stents (SS) had fewer stomas, but longer duration.
• Major complication rates were similar across groups; cumulative operating time higher in stoma groups (S vs P).

Conclusions:

• Primary anastomosis is recommended for stable patients with obstructive CRC.
• Hartmann's procedure is indicated for critical cases.
• Self-expanding metallic stents (SEMS) are suitable for palliative intent; stomas for neoadjuvant therapy.