Standard and multivisceral colectomy in locally advanced colon cancer
, , , et | 28 mai 2020
À propos de cet article
Article Category: Research Article
Publié en ligne: 28 mai 2020
Pages: 341 - 346
Reçu: 21 févr. 2020
Accepté: 30 avr. 2020
DOI: https://doi.org/10.2478/raon-2020-0032
© 2020 Artur M. Sahakyan, Andranik Aleksanyan, Hovhannes Batikyan, Hmayak Petrosyan, Mushegh А. Sahakyan, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
Organs and structures resected during multivisceral colectomies (n = 91) for locally advanced colon cancer
| Small bowel | 18 |
| Stomach | 13 |
| Uterus and/or ovaries | 13 |
| Kidney/Ureter/Urinary bladder | 11 |
| Liver | 11 |
| Gallbladder | 3 |
| Pancreas | 1 |
| > 1 organ/structure | 21 |
Outcomes of colectomy for locally advanced colon cancer depending on the type of resection (standard and multivisceral)
| Variables | Standard | Multivisceral | p-value |
|---|---|---|---|
| Age, years, mean (±SD) | 63.5 (11.7) | 62.5 (11.3) | 0.57 |
| Body mass index, kg/m2, mean (±SD) | 27.5 (5.3) | 26.2 (4.2) | 0.41 |
| Gender, n (%) | 0.78 | ||
| Male | 63 (56.2%) | 53 (58.2%) | |
| Female | 49 (43.8%) | 38 (41.8%) | |
| Comorbidities, n (%) | 98 (87.5%) | 84 (92.3%) | 0.26 |
| Number of comorbidities, mean (±SD) | 2.6 (0.9) | 2.6 (1.0) | 0.62 |
| Type of comorbidities, n (%) | 0.55 | ||
| Cardiovascular | 66 (58.9%) | 56 (61.5%) | |
| Diabetes mellitus | 9 (8 %) | 3 (3.3%) | |
| Thrombophlebitis | 13 (11.6%) | 9 (9.9%) | |
| ASA score > III, n (%) | 1 (0.9%) | 4 (4.4%) | 0.07 |
| Colonic obstruction, n (%) | 54 (48.2%) | 28 (30.8%) | 0.16 |
| Hemoglobin, g/dl, mean (±SD) | 114 (28) | 107 (29) | 0.11 |
| Total protein, g/dl, mean (±SD) | 69 (14.9) | 72.8 (5.9) | 0.045 |
| Albumin, g/dl, mean (±SD) | 40.1 (6.2) | 39.2 (6.2) | 0.6 |
| CEA, ng/ml, median (range) | 3.0 (0.7–267) | 7.5 (0.8–1155) | 0.52 |
| CA 19-9, U/ml, median (range) | 8.6 (0.6–13444) | 7.7 (2–2147) | 0.96 |
| Tumor location, n (%) | 0.07 | ||
| Right | 45 (40.2%) | 23 (25.3%) | |
| Left | 60 (53.6%) | 58 (63.7%) | |
| Transverse colon | 7 (6.2%) | 10 (11%) | |
| T stage, n (%) | < 0.01 | ||
| T4a | 74 (66.1%) | 5 (5.5%) | |
| T4b | 38 (33.9%) | 86 (94.5%) | |
| N stage, n (%) | 0.2 | ||
| N0 | 45 (40.2%) | 38 (41.8%) | |
| N1 | 21 (18.8%) | 25 (27.5%) | |
| ≥ N2 | 46 (41.1%) | 28 (30.8%) | |
| M1 stage, n (%) | 35 (31.2%) | 23 (25.3%) | 0.35 |
| Tumor size ≥ 6cm, n (%) | 91 (81.2%) | 78 (85.7%) | 0.4 |
| Operative time, min, median (range) | 140 (60–480) | 180 (85–390) | < 0.01 |
| Estimated (range) blood loss, ml, median | 100 (50-900) | 200 (100–600) | 0.01 |
| Red blood cell transfusion, n (%) | 10 (8.9%) | 20 (22.0%) | 0.01 |
| Morbidity (≥ II C-D), n (%) | 15 (13.4%) | 10 (11%) | 0.6 |
| Severe morbidity (≥ IIIa C-D), n (%) | 8 (7.1%) | 4 (4.4%) | 0.41 |
| CCI, median (range) | 33.7 (20.9–100) | 29.6 (20.9–100) | 0.33 |
| Anastomosis leakage, n (%) | 5 (4.5%) | 5 (5.5%) | 0.76 |
| Relaparotomy, n (%) | 5 (4.5%) | 5 (5.5%) | 0.76 |
| Mortality, n (%) | 2 (1.8%) | 3 (3.3%) | 0.66 |
| Postoperative (range) stay, days, median | 10 (5–44) | 11 (7–44) | 0.04 |
Patient characteristics and perioperative outcomes in patients with T4 colon cancer undergoing colectomy
| Variables | (n = 203) |
|---|---|
| Age, years, mean (± SD) | 63.1 (11.6) |
| Body mass index, kg/m2, mean (± SD) | 27 (4.9) |
| Female gender, n (%) | 87 (42.9%) |
| Comorbidities, n (%) | 21 (10.3%) |
| ASA score > III, n (%) | 5 (2.4%) |
| Colonic obstruction, n (%) | 82 (40.4%) |
| Hemoglobin, mean (± SD) | 111 (29) |
| Total protein, mean (± SD) | 72 (6) |
| Albumin, mean (± SD) | 40 (6) |
| Tumor location, n (%) | |
| Right | 68 (33.5%) |
| Left | 118 (58.1%) |
| Transverse colon | 17 (8.4%) |
| T stage, n (%) | |
| T4a | 79 (38.9%) |
| T4b | 124 (61.1%) |
| N stage, n (%) | |
| N0 | 83 (40.9%) |
| N1 | 46 (22.7%) |
| ≥ N2 | 74 (36.4%) |
| M stage, n (%) | |
| M0 | 145 (71.4%) |
| M1 | 58 (28.6%) |
| Tumor size ≥ 6cm, n (%) | 169 (83.3%) |
| Operative time, min, median (range) | 160 (60–480) |
| Estimated blood loss, ml, median (range) | 175 (50–900) |
| Red blood cell transfusion, n (%) | 30 (14.8%) |
| Morbidity (≥ II C–D), n (%) | 25 (12.3%) |
| Severe morbidity (≥ IIIa C–D), n (%) | 12 (5.9%) |
| Anastomosis leakage, n (%) | 10 (4.9%) |
| Relaparotomy, n (%) | 10 (4.9%) |
| Mortality, n (%) | 5 (2.5%) |
| Postoperative stay, days, median (range) | 11 (5–44) |
Multivariable analysis of risk factors for postoperative complications
| Variables | Odds ratio (95% confidence interval) | p-value |
|---|---|---|
| Male gender | 1.88 (0.7–5.04) | 0.21 |
| Number of comorbidities ≥ 3 | 3.1 (1.1–9.2) | 0.04 |
| Left-sided tumor | 2.2 (0.74–6.48) | 0.16 |
| Red blood cell transfusion | 1.94 (0.67–5.64) | 0.22 |
Univariable analysis of factors associated with postoperative complications
| Variables | Complications | No complications (n=178) | p-value |
|---|---|---|---|
| Age ≥ 65 years, n (%) | 15 (60%) | 98 (55.1%) | 0.68 |
| Body mass index ≥ 30 kg/m2, n (%) | 2 (8%) | 36 (20.2%) | 0.44 |
| Male gender, n (%) | 18 (72%) | 98 (55.1%) | 0.09 |
| Comorbidities, n (%) | 1 (4%) | 20 (11.2%) | 0.48 |
| Number of comorbidities ≥ 3, n (%) | 7 (28%) | 18 (10.1%) | 0.02 |
| Cardiovascular disease n (%) | 15 (60%) | 107 (60.1%) | 0.85 |
| ASA score > III, n (%) | 1 (4%) | 4 (2.2%) | 0.51 |
| Colon obstruction, n (%) | 12 (48%) | 70 (39.3%) | 0.78 |
| Hemoglobin, g/dl, mean (±SD) | 111 (27) | 111 (28) | 0.94 |
| Total protein, g/dl, mean (±SD) | 73.3 (5.5) | 72.1 (6.2) | 0.27 |
| Albumin, g/dl, mean (±SD) | 38.5 (4.7) | 39.8 (6.5) | 0.55 |
| Tumor location, n (%) | 0.05 | ||
| Right | 5 (20%) | 63 (35.4%) | |
| Left | 20 (80%) | 98 (55.1%) | |
| T stage, n (%) | 0.23 | ||
| T4a | 7 (28%) | 72 (40.4%) | |
| T4b | 18 (72%) | 106 (59.6%) | |
| N+ disease, n (%) | 17 (68%) | 103 (57.9%) | 0.6 |
| M1 stage, n (%) | 9 (36%) | 49 (27.5%) | 0.38 |
| Tumor size ≥ 6cm, n (%) | 21 (84%) | 148 (83.1%) | 1.0 |
| Estimated blood loss, ml, median (range) | 200 (50–900) | 100 (100–500) | 0.12 |
| Red blood cell transfusion, n (%) | 7 (28%) | 23 (12.9%) | 0.07 |
| ≥ 2 organs resected, n (%) | 3 (12%) | 18 (10.1%) | 0.73 |
| Single-layer anastomosis suture, n (%) | 15 (60%) | 136 (76.4%) | 0.13 |
| End-to-end anastomosis, n (%) | 9 (36%) | 53 (29.8%) | 0.57 |