[Extend of colonic excision in the curative treatment of cancers of the left colon. Left or segmental hemicolectomy? A controlled prospective multicenter study].
The ideal extent of colic excision in the curative treatment of left colic cancers has not yet been defined. The aim of this study is to compare the survival rates following left hemicolectomy and segmental colectomy. Over a period of 5 years from 1980 to 1985, 270 consecutive patients with cancer of the left colon without visceral metastases nor invasion of neighboring organs were included in the study. Survival at 5 years was the main criterion of assessment, with mortality and morbidity being the secondary criteria. 10 patients were excluded a posteriori. Out of the remaining 260 patients, 131 were operated with left hemicolectomy and 129 with segmental colectomy. Both groups were comparable as regards age; sex, risk factors (diabetes, renal failure), radiation therapy, antimitotics, procedure of anastomosis (hand or machine), protective colostomy, size of the tumor, and Dukes' stage. Only the length of the colon resected proximel to the tumor was greater in left hemicolectomy. 16% of the patients had a Dukes A adenocarcinoma. Postoperative mortality was higher after left hemicolectomy (6.1%) than after segmental colectomy (2.3%), but not significantly. Morbidity was similar. The survival rate at 5 years, including immediate deaths, was 64.8% after left hemicolectomy and 65.8% after segmental colectomy. Both survival charts could be strictly superimposed without significant differences. Left hemicolectomy therefore produced results that were comparable to those of segmental colectomy.
Rouffet
F
F
Service de Chirurgie Viscérale et Vasculaire, Hôpital de Juvisy, Juvisy-sur-Orge.
Mathon
C
C
Vendroux
J
J
D003082:Colectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D003110:Colonic Neoplasms / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D011446:Prospective Studies; D015996:Survival Rate; D013536:Suture Techniques
Etendue de l'exérèse colique dans le traitement curatif des cancers du colon gauche. Hémicolectomie gauche ou colectomie segmentaire? Essai prospectif multicentrique contrôlé.