CURATIVE RESECTION FOR LEFT COLONIC-CARCINOMA - HEMICOLECTOMY VS SEGMENTAL COLECTOMY - A PROSPECTIVE, CONTROLLED, MULTICENTER TRIAL

PURPOSE: This study was developed to compare median and actuarial surv ival after left hemicolectomy vs. left segmental colectomy. METHODS: B etween January 1980 and January 1985, 270 consecutive patients (133 ma les and 137 females; mean age, 64 +/- 12 (range, 18-98) years with lef t colonic carcinoma located between the left third of the transverse c olon and (but not, including) the colorectal juncture were randomly al lotted to undergo either left hemicolectomy or left segmental colectom y. Left hemicolectomy removed the entire left colon along with the ori gin of the inferior mesenteric artery and the dependent lymphatic terr itory. Left segmental colectomy removed a more restricted segment of t he colon and left the origin of the inferior mesenteric artery unmoles ted. RESULTS: After elimination of 10 patients for protocol violation, 131 patients with left hemicolectomy and 129 with left segmental cole ctomy were analyzed. Both groups were similar with regard to preoperat ive risk factors (age, sex, obesity, weight loss, anemia, diabetes, ci rrhosis, kidney failure, steroid therapy or radiation therapy performe d for any cause other than cancer), pathology findings (size, degree o f differentiation, Dukes stage, invasion of lymph nodes at the origin of the inferior mesenteric artery), and associated lesions. Only the l ength 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, ea rly postoperative mortality was 4 percent higher, but not significantl y in left hemicolectomy (eight deaths, 6 percent) than in left segment al colectomy (three deaths, 2 percent). Median survival was 10 years a nd nearly equivalent in both groups. The two actuarial survival curves were similar. Bowel movement frequency was significantly increased af ter left hemicolectomy during the first postoperative year. Our result s suggest that survival after left segmental colectomy is equivalent t o that of left hemicolectomy. Notwithstanding the observation of other carcinologic rules, left segmental colectomy rather than left hemicol ectomy may theoretically be performed under laparoscopy without compro mising the carcinologic outcome.