Long-term oncological results after laparoscopic sigmoidectomy for adenocarcinoma
EAES Academy. Balla A. 07/05/22; 363015; P058
Dr. Andrea Balla
Contributions
Contributions
Abstract
Aims:
Currently, the surgery of choice in the case of sigmoid cancer is left hemicolectomy. Sigmoidectomy is an intervention reserved in most of cases for benign pathologies and mainly in cases of diverticulitis. Few studies in the literature report oncological data after sigmoidectomy for adenocarcinoma. Aim of this study is to report long-term outcomes after laparoscopic sigmoidectomy (LS) for sigmoid adenocarcinoma.
Methods:
This study is a retrospective analysis of prospectively collected data. From January 2003 to February 2021, 173 patients underwent elective LS for adenocarcinoma. Twenty-four patients with diagnosis of preoperative distant metastases were excluded (13.9%). Follow-up data of the remaining 149 patients were obtained from Unit of Oncology.
Results:
Fifty-one out of 149 patients (34.2%) were lost at follow-up, leaving 98 patients with sufficient data for analysis and forming our study population. Conversion to open surgery was required in three patients for adhesions to previous surgery (3%). Mean operative time was 139.9 ± 35.1 minutes (range 60-300 minutes). Overall, seven postoperative complications were observed (7.1%). Two patients (2%) with anastomotic leakage underwent Hartmann procedure (Clavien-Dindo grade III-b). Mean number of lymph-nodes harvested on the specimen was 14.2 ± 7.1 (range 5-47). Mean postoperative hospital stay was 8.8 ± 4.5 days (range 5-42). Readmission and 30-day mortality were nil. At median follow-up of 115 months (interquartile range 133.8) two (2%) and 9 patients (9.2%) developed recurrences and metastases, respectively. Twelve patients (12.2%) died during the study period. Of these, six patients (6.1%) with metastases died for tumor disease progression, and other six patients died for causes not related to the tumor. At 5- and 10-years follow-up the overall survival was 90.5 ± 3.4% and 83.8 ± 4.5%, while disease free survival was 87.1 ± 4.1% and 83.5 ± 4.7%, respectively.
Conclusions:
LS for adenocarcinoma is a safe and comparable technique to left hemicolectomy both in terms of the number of resected lymph nodes and of oncological results at 10 years. The possibility of sparing the colon to be resected even lowering the splenic flexure can cause a lower rate of anastomotic fistulas. Further studies are needed to confirm these data.
Currently, the surgery of choice in the case of sigmoid cancer is left hemicolectomy. Sigmoidectomy is an intervention reserved in most of cases for benign pathologies and mainly in cases of diverticulitis. Few studies in the literature report oncological data after sigmoidectomy for adenocarcinoma. Aim of this study is to report long-term outcomes after laparoscopic sigmoidectomy (LS) for sigmoid adenocarcinoma.
Methods:
This study is a retrospective analysis of prospectively collected data. From January 2003 to February 2021, 173 patients underwent elective LS for adenocarcinoma. Twenty-four patients with diagnosis of preoperative distant metastases were excluded (13.9%). Follow-up data of the remaining 149 patients were obtained from Unit of Oncology.
Results:
Fifty-one out of 149 patients (34.2%) were lost at follow-up, leaving 98 patients with sufficient data for analysis and forming our study population. Conversion to open surgery was required in three patients for adhesions to previous surgery (3%). Mean operative time was 139.9 ± 35.1 minutes (range 60-300 minutes). Overall, seven postoperative complications were observed (7.1%). Two patients (2%) with anastomotic leakage underwent Hartmann procedure (Clavien-Dindo grade III-b). Mean number of lymph-nodes harvested on the specimen was 14.2 ± 7.1 (range 5-47). Mean postoperative hospital stay was 8.8 ± 4.5 days (range 5-42). Readmission and 30-day mortality were nil. At median follow-up of 115 months (interquartile range 133.8) two (2%) and 9 patients (9.2%) developed recurrences and metastases, respectively. Twelve patients (12.2%) died during the study period. Of these, six patients (6.1%) with metastases died for tumor disease progression, and other six patients died for causes not related to the tumor. At 5- and 10-years follow-up the overall survival was 90.5 ± 3.4% and 83.8 ± 4.5%, while disease free survival was 87.1 ± 4.1% and 83.5 ± 4.7%, respectively.
Conclusions:
LS for adenocarcinoma is a safe and comparable technique to left hemicolectomy both in terms of the number of resected lymph nodes and of oncological results at 10 years. The possibility of sparing the colon to be resected even lowering the splenic flexure can cause a lower rate of anastomotic fistulas. Further studies are needed to confirm these data.
Aims:
Currently, the surgery of choice in the case of sigmoid cancer is left hemicolectomy. Sigmoidectomy is an intervention reserved in most of cases for benign pathologies and mainly in cases of diverticulitis. Few studies in the literature report oncological data after sigmoidectomy for adenocarcinoma. Aim of this study is to report long-term outcomes after laparoscopic sigmoidectomy (LS) for sigmoid adenocarcinoma.
Methods:
This study is a retrospective analysis of prospectively collected data. From January 2003 to February 2021, 173 patients underwent elective LS for adenocarcinoma. Twenty-four patients with diagnosis of preoperative distant metastases were excluded (13.9%). Follow-up data of the remaining 149 patients were obtained from Unit of Oncology.
Results:
Fifty-one out of 149 patients (34.2%) were lost at follow-up, leaving 98 patients with sufficient data for analysis and forming our study population. Conversion to open surgery was required in three patients for adhesions to previous surgery (3%). Mean operative time was 139.9 ± 35.1 minutes (range 60-300 minutes). Overall, seven postoperative complications were observed (7.1%). Two patients (2%) with anastomotic leakage underwent Hartmann procedure (Clavien-Dindo grade III-b). Mean number of lymph-nodes harvested on the specimen was 14.2 ± 7.1 (range 5-47). Mean postoperative hospital stay was 8.8 ± 4.5 days (range 5-42). Readmission and 30-day mortality were nil. At median follow-up of 115 months (interquartile range 133.8) two (2%) and 9 patients (9.2%) developed recurrences and metastases, respectively. Twelve patients (12.2%) died during the study period. Of these, six patients (6.1%) with metastases died for tumor disease progression, and other six patients died for causes not related to the tumor. At 5- and 10-years follow-up the overall survival was 90.5 ± 3.4% and 83.8 ± 4.5%, while disease free survival was 87.1 ± 4.1% and 83.5 ± 4.7%, respectively.
Conclusions:
LS for adenocarcinoma is a safe and comparable technique to left hemicolectomy both in terms of the number of resected lymph nodes and of oncological results at 10 years. The possibility of sparing the colon to be resected even lowering the splenic flexure can cause a lower rate of anastomotic fistulas. Further studies are needed to confirm these data.
Currently, the surgery of choice in the case of sigmoid cancer is left hemicolectomy. Sigmoidectomy is an intervention reserved in most of cases for benign pathologies and mainly in cases of diverticulitis. Few studies in the literature report oncological data after sigmoidectomy for adenocarcinoma. Aim of this study is to report long-term outcomes after laparoscopic sigmoidectomy (LS) for sigmoid adenocarcinoma.
Methods:
This study is a retrospective analysis of prospectively collected data. From January 2003 to February 2021, 173 patients underwent elective LS for adenocarcinoma. Twenty-four patients with diagnosis of preoperative distant metastases were excluded (13.9%). Follow-up data of the remaining 149 patients were obtained from Unit of Oncology.
Results:
Fifty-one out of 149 patients (34.2%) were lost at follow-up, leaving 98 patients with sufficient data for analysis and forming our study population. Conversion to open surgery was required in three patients for adhesions to previous surgery (3%). Mean operative time was 139.9 ± 35.1 minutes (range 60-300 minutes). Overall, seven postoperative complications were observed (7.1%). Two patients (2%) with anastomotic leakage underwent Hartmann procedure (Clavien-Dindo grade III-b). Mean number of lymph-nodes harvested on the specimen was 14.2 ± 7.1 (range 5-47). Mean postoperative hospital stay was 8.8 ± 4.5 days (range 5-42). Readmission and 30-day mortality were nil. At median follow-up of 115 months (interquartile range 133.8) two (2%) and 9 patients (9.2%) developed recurrences and metastases, respectively. Twelve patients (12.2%) died during the study period. Of these, six patients (6.1%) with metastases died for tumor disease progression, and other six patients died for causes not related to the tumor. At 5- and 10-years follow-up the overall survival was 90.5 ± 3.4% and 83.8 ± 4.5%, while disease free survival was 87.1 ± 4.1% and 83.5 ± 4.7%, respectively.
Conclusions:
LS for adenocarcinoma is a safe and comparable technique to left hemicolectomy both in terms of the number of resected lymph nodes and of oncological results at 10 years. The possibility of sparing the colon to be resected even lowering the splenic flexure can cause a lower rate of anastomotic fistulas. Further studies are needed to confirm these data.
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