Guidelenines in the management of obstructing cancer of the left colon: Consensus conference of the world society of emergency surgery (WSES) and peritoneum and surgery (PnS) society

Luca Ansaloni, Roland E. Andersson, Franco Bazzoli, Fausto Catena, Vincenzo Cennamo, Salomone Di Saverio, Lorenzo Fuccio, Hans Jeekel, Ari Leppäniemi, Ernest Moore, Antonio D. Pinna, Michele Pisano, Alessandro Repici, Paul H. Sugarbaker, Jean Jaques Tuech

Research output: Contribution to journalArticle

100 Citations (Scopus)

Abstract

Background: Obstructive left colon carcinoma (OLCC) is a challenging matter in terms of obstruction release as well of oncological issues. Several options are available and no guidelines are established. The paper aims to generate evidenced based recommendations on management of OLCC.Methods: The PubMed and Cochrane Library databases were queried for publications focusing on OLCC published prior to April 2010. A extensive retrieval, analyses, and grading of the literature was undertaken. The findings of the research were presented and largely discussed among panellist and audience at the Consensus Conference of the World Society of Emergency Surgery (WSES) and Peritoneum and Surgery (PnS) Society held in Bologna July 2010. Comparisons of techniques are presented and final committee recommendation are enounced.Results: Hartmann's procedure should be preferred to loop colostomy (Grade 2B). Hartmann's procedure offers no survival benefit compared to segmental colonic resection with primary anastomosis (Grade 2C+); Hartmann's procedure should be considered in patients with high surgical risk (Grade 2C). Total colectomy and segmental colectomy with intraoperative colonic irrigation are associated with same mortality/morbidity, however total colectomy is associated with higher rates impaired bowel function (Grade 1A). Segmental resection and primary anastomosis either with manual decompression or intraoperative colonic irrigation are associated with same mortality/morbidity rate (Grade 1A). In palliation stent placement is associated with similar mortality/morbidity rates and shorter hospital stay (Grade 2B). Stents as a bridge to surgery seems associated with lower mortality rate, shorter hospital stay, and a lower colostomy formation rate (Grade 1B).Conclusions: Loop colostomy and staged procedure should be adopted in case of dramatic scenario, when neoadjuvant therapy could be expected. Hartmann's procedure should be performed in case of high risk of anastomotic dehiscence. Subtotal and total colectomy should be attempted when cecal perforation or in case of synchronous colonic neoplasm. Primary resection and anastomosis with manual decompression seems the procedure of choice. Colonic stents represent the best option when skills are available. The literature power is relatively poor and the existing RCT are often not sufficiently robust in design thus, among 6 possible treatment modalities, only 2 reached the Grade A.

Original languageEnglish
Article number29
JournalWorld Journal of Emergency Surgery
Volume5
Issue number1
DOIs
Publication statusPublished - Dec 28 2010

Fingerprint

Peritoneum
Colonic Neoplasms
Emergencies
Colectomy
Colostomy
Stents
Colon
Mortality
Decompression
Morbidity
Carcinoma
Length of Stay
Multiple Primary Neoplasms
Neoadjuvant Therapy
PubMed
Libraries
Publications
Databases
Guidelines
Survival

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine

Cite this

Guidelenines in the management of obstructing cancer of the left colon : Consensus conference of the world society of emergency surgery (WSES) and peritoneum and surgery (PnS) society. / Ansaloni, Luca; Andersson, Roland E.; Bazzoli, Franco; Catena, Fausto; Cennamo, Vincenzo; Di Saverio, Salomone; Fuccio, Lorenzo; Jeekel, Hans; Leppäniemi, Ari; Moore, Ernest; Pinna, Antonio D.; Pisano, Michele; Repici, Alessandro; Sugarbaker, Paul H.; Tuech, Jean Jaques.

In: World Journal of Emergency Surgery, Vol. 5, No. 1, 29, 28.12.2010.

Research output: Contribution to journalArticle

Ansaloni, L, Andersson, RE, Bazzoli, F, Catena, F, Cennamo, V, Di Saverio, S, Fuccio, L, Jeekel, H, Leppäniemi, A, Moore, E, Pinna, AD, Pisano, M, Repici, A, Sugarbaker, PH & Tuech, JJ 2010, 'Guidelenines in the management of obstructing cancer of the left colon: Consensus conference of the world society of emergency surgery (WSES) and peritoneum and surgery (PnS) society', World Journal of Emergency Surgery, vol. 5, no. 1, 29. https://doi.org/10.1186/1749-7922-5-29
Ansaloni, Luca ; Andersson, Roland E. ; Bazzoli, Franco ; Catena, Fausto ; Cennamo, Vincenzo ; Di Saverio, Salomone ; Fuccio, Lorenzo ; Jeekel, Hans ; Leppäniemi, Ari ; Moore, Ernest ; Pinna, Antonio D. ; Pisano, Michele ; Repici, Alessandro ; Sugarbaker, Paul H. ; Tuech, Jean Jaques. / Guidelenines in the management of obstructing cancer of the left colon : Consensus conference of the world society of emergency surgery (WSES) and peritoneum and surgery (PnS) society. In: World Journal of Emergency Surgery. 2010 ; Vol. 5, No. 1.
@article{ecc308fb3c664bee94a5b8f5ed0c6f2f,
title = "Guidelenines in the management of obstructing cancer of the left colon: Consensus conference of the world society of emergency surgery (WSES) and peritoneum and surgery (PnS) society",
abstract = "Background: Obstructive left colon carcinoma (OLCC) is a challenging matter in terms of obstruction release as well of oncological issues. Several options are available and no guidelines are established. The paper aims to generate evidenced based recommendations on management of OLCC.Methods: The PubMed and Cochrane Library databases were queried for publications focusing on OLCC published prior to April 2010. A extensive retrieval, analyses, and grading of the literature was undertaken. The findings of the research were presented and largely discussed among panellist and audience at the Consensus Conference of the World Society of Emergency Surgery (WSES) and Peritoneum and Surgery (PnS) Society held in Bologna July 2010. Comparisons of techniques are presented and final committee recommendation are enounced.Results: Hartmann's procedure should be preferred to loop colostomy (Grade 2B). Hartmann's procedure offers no survival benefit compared to segmental colonic resection with primary anastomosis (Grade 2C+); Hartmann's procedure should be considered in patients with high surgical risk (Grade 2C). Total colectomy and segmental colectomy with intraoperative colonic irrigation are associated with same mortality/morbidity, however total colectomy is associated with higher rates impaired bowel function (Grade 1A). Segmental resection and primary anastomosis either with manual decompression or intraoperative colonic irrigation are associated with same mortality/morbidity rate (Grade 1A). In palliation stent placement is associated with similar mortality/morbidity rates and shorter hospital stay (Grade 2B). Stents as a bridge to surgery seems associated with lower mortality rate, shorter hospital stay, and a lower colostomy formation rate (Grade 1B).Conclusions: Loop colostomy and staged procedure should be adopted in case of dramatic scenario, when neoadjuvant therapy could be expected. Hartmann's procedure should be performed in case of high risk of anastomotic dehiscence. Subtotal and total colectomy should be attempted when cecal perforation or in case of synchronous colonic neoplasm. Primary resection and anastomosis with manual decompression seems the procedure of choice. Colonic stents represent the best option when skills are available. The literature power is relatively poor and the existing RCT are often not sufficiently robust in design thus, among 6 possible treatment modalities, only 2 reached the Grade A.",
author = "Luca Ansaloni and Andersson, {Roland E.} and Franco Bazzoli and Fausto Catena and Vincenzo Cennamo and {Di Saverio}, Salomone and Lorenzo Fuccio and Hans Jeekel and Ari Lepp{\"a}niemi and Ernest Moore and Pinna, {Antonio D.} and Michele Pisano and Alessandro Repici and Sugarbaker, {Paul H.} and Tuech, {Jean Jaques}",
year = "2010",
month = "12",
day = "28",
doi = "10.1186/1749-7922-5-29",
language = "English",
volume = "5",
journal = "World Journal of Emergency Surgery",
issn = "1749-7922",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Guidelenines in the management of obstructing cancer of the left colon

T2 - Consensus conference of the world society of emergency surgery (WSES) and peritoneum and surgery (PnS) society

AU - Ansaloni, Luca

AU - Andersson, Roland E.

AU - Bazzoli, Franco

AU - Catena, Fausto

AU - Cennamo, Vincenzo

AU - Di Saverio, Salomone

AU - Fuccio, Lorenzo

AU - Jeekel, Hans

AU - Leppäniemi, Ari

AU - Moore, Ernest

AU - Pinna, Antonio D.

AU - Pisano, Michele

AU - Repici, Alessandro

AU - Sugarbaker, Paul H.

AU - Tuech, Jean Jaques

PY - 2010/12/28

Y1 - 2010/12/28

N2 - Background: Obstructive left colon carcinoma (OLCC) is a challenging matter in terms of obstruction release as well of oncological issues. Several options are available and no guidelines are established. The paper aims to generate evidenced based recommendations on management of OLCC.Methods: The PubMed and Cochrane Library databases were queried for publications focusing on OLCC published prior to April 2010. A extensive retrieval, analyses, and grading of the literature was undertaken. The findings of the research were presented and largely discussed among panellist and audience at the Consensus Conference of the World Society of Emergency Surgery (WSES) and Peritoneum and Surgery (PnS) Society held in Bologna July 2010. Comparisons of techniques are presented and final committee recommendation are enounced.Results: Hartmann's procedure should be preferred to loop colostomy (Grade 2B). Hartmann's procedure offers no survival benefit compared to segmental colonic resection with primary anastomosis (Grade 2C+); Hartmann's procedure should be considered in patients with high surgical risk (Grade 2C). Total colectomy and segmental colectomy with intraoperative colonic irrigation are associated with same mortality/morbidity, however total colectomy is associated with higher rates impaired bowel function (Grade 1A). Segmental resection and primary anastomosis either with manual decompression or intraoperative colonic irrigation are associated with same mortality/morbidity rate (Grade 1A). In palliation stent placement is associated with similar mortality/morbidity rates and shorter hospital stay (Grade 2B). Stents as a bridge to surgery seems associated with lower mortality rate, shorter hospital stay, and a lower colostomy formation rate (Grade 1B).Conclusions: Loop colostomy and staged procedure should be adopted in case of dramatic scenario, when neoadjuvant therapy could be expected. Hartmann's procedure should be performed in case of high risk of anastomotic dehiscence. Subtotal and total colectomy should be attempted when cecal perforation or in case of synchronous colonic neoplasm. Primary resection and anastomosis with manual decompression seems the procedure of choice. Colonic stents represent the best option when skills are available. The literature power is relatively poor and the existing RCT are often not sufficiently robust in design thus, among 6 possible treatment modalities, only 2 reached the Grade A.

AB - Background: Obstructive left colon carcinoma (OLCC) is a challenging matter in terms of obstruction release as well of oncological issues. Several options are available and no guidelines are established. The paper aims to generate evidenced based recommendations on management of OLCC.Methods: The PubMed and Cochrane Library databases were queried for publications focusing on OLCC published prior to April 2010. A extensive retrieval, analyses, and grading of the literature was undertaken. The findings of the research were presented and largely discussed among panellist and audience at the Consensus Conference of the World Society of Emergency Surgery (WSES) and Peritoneum and Surgery (PnS) Society held in Bologna July 2010. Comparisons of techniques are presented and final committee recommendation are enounced.Results: Hartmann's procedure should be preferred to loop colostomy (Grade 2B). Hartmann's procedure offers no survival benefit compared to segmental colonic resection with primary anastomosis (Grade 2C+); Hartmann's procedure should be considered in patients with high surgical risk (Grade 2C). Total colectomy and segmental colectomy with intraoperative colonic irrigation are associated with same mortality/morbidity, however total colectomy is associated with higher rates impaired bowel function (Grade 1A). Segmental resection and primary anastomosis either with manual decompression or intraoperative colonic irrigation are associated with same mortality/morbidity rate (Grade 1A). In palliation stent placement is associated with similar mortality/morbidity rates and shorter hospital stay (Grade 2B). Stents as a bridge to surgery seems associated with lower mortality rate, shorter hospital stay, and a lower colostomy formation rate (Grade 1B).Conclusions: Loop colostomy and staged procedure should be adopted in case of dramatic scenario, when neoadjuvant therapy could be expected. Hartmann's procedure should be performed in case of high risk of anastomotic dehiscence. Subtotal and total colectomy should be attempted when cecal perforation or in case of synchronous colonic neoplasm. Primary resection and anastomosis with manual decompression seems the procedure of choice. Colonic stents represent the best option when skills are available. The literature power is relatively poor and the existing RCT are often not sufficiently robust in design thus, among 6 possible treatment modalities, only 2 reached the Grade A.

UR - http://www.scopus.com/inward/record.url?scp=78650547157&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78650547157&partnerID=8YFLogxK

U2 - 10.1186/1749-7922-5-29

DO - 10.1186/1749-7922-5-29

M3 - Article

C2 - 21189148

AN - SCOPUS:78650547157

VL - 5

JO - World Journal of Emergency Surgery

JF - World Journal of Emergency Surgery

SN - 1749-7922

IS - 1

M1 - 29

ER -