RESUMEN
Colorectal cancer (CRC) is a known complication of inflammatory bowel disease (IBD). Widely accepted guidelines recommend that patients with ulcerative colitis diagnosed with CRC undergo total proctocolectomy with or without ileal pouch-anal anastomosis, and that patients with Crohn's disease and CRC undergo either total colectomy or proctocolectomy. These approaches are ideal for preventing synchronous and metachronous cancer, minimizing risk of refractory colitis requiring reoperation, and is the appropriate treatment for the vast majority of patients with IBD who are diagnosed with CRC and require surgical intervention. Segmental colectomy, however, may be considered in select patients with IBD and CRC, specifically in elderly patients with short disease duration, in patients with mild colitis identified preoperatively, in patients with high operative risk and prohibitive comorbidities, and in patients whose CRC appears to be sporadic as opposed to colitis-associated. Patients undergoing segmental resection must be closely surveilled postoperatively for dysplasia, recurrent cancer, and refractory colitis.
RESUMEN
Background: Colorectal cancer is among the most common cancers in the world, and splenic flexure colon cancer accounts for about 2-5% of them. There is still no consensus on the surgical treatment of splenic flexure colon cancer (SFCC), and the extent of surgical resection and lymph node dissection for SFCC is still controversial. Aim: To compare the postoperative and long-term oncologic outcomes of extended right colectomy (ERC), segmental colectomy (SC) and left colectomy (LC) for SFCC. Method: Up to March 2024, retrospective and prospective studies of ERC, SC, and LC for SFCC were searched through databases. Pooled weighted/standardized mean difference (WMD/SMD), odds ratio (OR) and hazard ratio (HR) with 95% confidence interval (CI) were calculated using a fixed effects model or random effects model, and meta-analysis was performed using Stata. Results: This meta-analysis includes 5,918 patients from 13 studies with more lymph node harvest (OR:6.29; 95%Cl: 3.66-8.91; Z=4.69, P=0), more operation time (WMD: 22.53; 95%Cl: 18.75-26.31; Z=11.68, P=0), more blood loss (WMD:58.44; 95%Cl: 20.20-96.68; Z=2.99, P=0.003), longer hospital stay (WMD:1.74; 95%Cl: 0.20-3.29; Z=2.21, P=0.03), longer time to return to regular diet (WMD:3.17; 95%Cl: 2.05-4.30; Z=5.53, P=0), longer first flatus time (WMD:1.66; 95%Cl: 0.96-2.37; Z=4.61, P=0) in ERC versus SC. More lymph node harvest (WMD: 3.52; 95% Cl: 1.59-5.44; Z=3.58, P=0) in ERC versus LC and LC versus SC (WMD: 1.97; 95% CI: 0.53-3.41; Z=2.68, P=0.007), respectively. There is no significant difference between anastomotic leakage, postoperative ileus, total postoperative complication, severe postoperative complication, wound infection, reoperations, R0 resection, postoperative mortality, 5-year overall survival (OS), 5-year disease-free survival (DFS) in three group of patients. In LC versus SC and ERC versus LC, there is no difference between operation time, blood loss, hospital stay, return to regular diet, and first flatus. Conclusion: In the included studies, SC and LC may be more advantageous, with fewer postoperative complications and faster recovery. ERC harvests more lymph nodes, but there is no significant difference in long-term OS and DFS between the three surgical approaches. Given that the included studies were retrospective, more randomized controlled trials are needed to validate this conclusion.
RESUMEN
Resumen Introducción: El tratamiento estándar para los pacientes con colitis ulcerosa y displasia o adenocarcinoma de colon ha sido la proctocolectomía total, lo que conlleva una morbilidad y una reducción en la calidad de vida significativa. Materiales y Método: Se hace un análisis retrospectivo de 5 pacientes con colitis ulcerosa a los que se realiza una resección segmentaria por displasia o adenocarcinoma. Resultados: La mediana de edad al diagnóstico de colitis ulcerosa y de la neoplasia fue de 56 y 62 años respectivamente. El tiempo de evolución de la enfermedad fue de 1 a 13 años. La mediana de seguimiento postoperatorio fue de 57 meses apareciendo en uno de los pacientes un nuevo foco de displasia. Conclusiones: En determinados pacientes seleccionados, las resecciones segmentarias podrían ser una opción segura si tienen buen control de la enfermedad, escasa actividad inflamatoria, pocos años de evolución y que puedan realizar un adecuado seguimiento posterior.
Introduction: The historical management for patients with ulcerative colitis and displasia or adenocarcinoma associated was to perform a total proctocolectomy, what cause important morbidity and affect patient's quality of life. Materials and Method: A retrospective review about 5 patients with a segmental colectomy due to dysplasia or adenocarcinoma is done. Results: The median age at diagnosis of ulcerative colitis and cancer was 56 and 62 years respectively. Disease time evolution was between 1 and 13 years. The patients were followed up for a median of 57 months. During the follow-up evaluation, 1 patient was found to have dysplasia. Conclusion: Segmental colectomy could be a safe option in clinically stable patients, few years of diagnosis and with and a suitable follow up.