| Curative resection for left colonic carcinoma: hemicolectomy vs. segmental colectomy. A prospective, controlled, multicenter trial. French Association for Surgical Research. | |
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MedLine Citation:
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PMID: 8026230 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: This study was developed to compare median and actuarial survival after left hemicolectomy vs. left segmental colectomy. METHODS: Between January 1980 and January 1985, 270 consecutive patients (133 males and 137 females; mean age, 64 +/- 12 (range, 18-91) years with left colonic carcinoma located between the left third of the transverse colon and (but not, including) the colorectal juncture were randomly allotted to undergo either left hemicolectomy or left segmental colectomy. Left hemicolectomy removed the entire left colon along with the origin of the inferior mesenteric artery and the dependent lymphatic territory. Left segmental colectomy removed a more restricted segment of the colon and left the origin of the inferior mesenteric artery unmolested. RESULTS: After elimination of 10 patients for protocol violation, 131 patients with left hemicolectomy and 129 with left segmental colectomy were analyzed. Both groups were similar with regard to preoperative risk factors (age, sex, obesity, weight loss, anemia, diabetes, cirrhosis, kidney failure, steroid therapy or radiation therapy performed for any cause other than cancer), pathology findings (size, degree of differentiation, Dukes stage, invasion of lymph nodes at the origin of the inferior mesenteric artery), and associated lesions. Only the length of tumor-free margins of colon removed was significantly longer in left hemicolectomy. The number of early postoperative abdominal and extra-abdominal complications was similar in both groups. Overall, early postoperative mortality was 4 percent higher, but not significantly in left hemicolectomy (eight deaths, 6 percent) than in left segmental colectomy (three deaths, 2 percent). Median survival was 10 years and nearly equivalent in both groups. The two actuarial survival curves were similar. Bowel movement frequency was significantly increased after left hemicolectomy during the first postoperative year. Our results suggest that survival after left segmental colectomy is equivalent to that of left hemicolectomy. Notwithstanding the observation of other carcinologic rules, left segmental colectomy rather than left hemicolectomy may theoretically be performed under laparoscopy without compromising the carcinologic outcome. |
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Authors:
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F Rouffet; J M Hay; B Vacher; A Fingerhut; A Elhadad; Y Flamant; C Mathon; A Gainant |
Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial |
Journal Detail:
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Title: Diseases of the colon and rectum Volume: 37 ISSN: 0012-3706 ISO Abbreviation: Dis. Colon Rectum Publication Date: 1994 Jul |
Date Detail:
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Created Date: 1994-08-11 Completed Date: 1994-08-11 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0372764 Medline TA: Dis Colon Rectum Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 651-9 Citation Subset: IM |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adenocarcinoma
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mortality,
secondary,
surgery* Adolescent Adult Aged Aged, 80 and over Colectomy / methods*, mortality Colonic Neoplasms / mortality, pathology, surgery* Female Follow-Up Studies France Humans Lymphatic Metastasis Male Middle Aged Neoplasm Invasiveness Neoplasm Staging Postoperative Complications / mortality Preoperative Care Prognosis Prospective Studies Risk Factors Survival Rate Time Factors |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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