One-Stage Colectomy in the Management of Acutely Obstructed Left Colon Cancer

Abstract

One-stage subtotal colectomy of an acutely obstructed colon would improve quality of life while shortening the length of hospitalization. Prohibitive surgical risks, though, are commonly ascribed to such an approach. Analyzing the senior author’s experience we compared the one-stage approach versus multistaged resection concerning operative mortality and morbidity rates and the duration of hospital stay. Forty-nine out of 291 (17%) large bowel cancer patients presented with acute left-sided obstruction requiring emergency surgery. Colostomy alone was performed in 18 (37%), multistaged colectomy in 20 (41 %, group A) and one-stage subtotal colectomy in 11 (22%, group B), from January 1973 through September 1990. Both groups were comparable regarding age and sex distribution, TNM staging and ASA classification. Operative mortality and morbidity rates were 10 and 30% in group A and 9 and 18% in group B, respectively. The average length of hospital stay was more than twice the number of days in group A. Whenever an experienced surgical team is available and in the absence of contraindications (local factors precluding a swift dissection, hemodynamic instability, gangrenous bowel) a one-stage subtotal colectomy, taking advantage of a better healing ileo-low-sigmoid anastomosis, carries acceptable mortality and morbidity risks while enhancing the quality of life and shortening the length of hospitalization. It should be considered the procedure of choice, provided selection requirements and technical demands are met.

Systematic evaluation of surgical strategies for acute malignant left-sided colonic obstruction

“…2). Six studies demonstrated similar results between the two groups 12,13,22,26,30,31 . Only Huddy et al 23 reported, in a relatively small (42 patients) and methodologically poor study, that results were better for two-or three-stage procedures.…”

“…4). The randomized Subtotal Colectomy versus On- Table Irrigation (11) Huddy et al 23 1 of 27 (4) 6 of 15 (40) Stephenson et al 29 2 of 15 (13) 1 of 34 (3) de Almeida et al 22 1 of 11 (9) 2 of 20 (10) Runkel et al 13 1 of 6 (17) 3 of 21 (14) Kasperk et al 24 34 of 102 (33) 7 of 32 (22) Mochizuki et al 27 2 of 11 (18) 1 of 44 (2) Lau et al 25 3 of 9 (33) 2 of 35 (6) Turan et al (0) Zorcolo et al 33 6 of 24 (25) 6 of 93 (6) Meyer et al 26 34 of 268 (13) 38 of 358 (11) Villar et al 31 1 of 20 (5) 2 of 43 (5) Poon et al (Fig. 5).…”

“…− 31 to 13) per cent) showed similar results in both groups. Tomiki et al 41 (18) 7 of 11 (64) 1 of 9 (11) 6 of 9 (67) 19 of 37 (51) 13 of 24 (54) 107 of 213 (50) 10 of 20 (50) 6 of 20 (30) 4 of 44 (9) 9 of 35 (26) 5 of 14 (36) 17 of 33 (52) 26 of 93 (28) 145 of 340 (43) 17 of 43 (40) Stephenson et al 29 de Almeida et al 22 Mochizuki et al 27 Lau et al 25 Aguilar-Nascimento et al 21 Turan et al 30 Zorcolo et al 33 Meyer et al 26 Villar et al 31 Risk difference (%) One stage Two or three stages Risk difference (%) Morbidity risk (13) 2 of 35 (6) 1 of 8 (13) 5 of 44 (11) 1 of 31 (3) 1 of 35 (3) 2 (−12, 15) (Fig. 7).…”