Primary Resection and Anastomosis in Obstructed Descending Colon due to Cancer

Abstract

Intraoperative colonic irrigation followed by one-stage resection is gaining popularity as the optimal surgical treatment for left-sided colonic obstruction. However, its efficacy and potential hazards have not been adequately tested in obstruction due to colonic cancer. We analyzed the early results of 23 consecutive patients with obstructive left-sided colonic carcinoma treated by primary resection and anastomosis following intraoperative antegrade colonic lavage. Two patients (8.6%) died, one from complication of anastomotic leakage. The significant postoperative complications were chest infection in three (13%) and wound infection in seven (30.4%). The average hospital stay was 16.5 days. The results of this study suggest that intraoperative bowel irrigation permits one-stage resection and anastomosis to be conducted with reasonable safety provided care is taken in operative techniques.

Colonic Stents for the Palliation of Malignant Colonic Obstruction

“…Moreover, many patients are unable to undergo planned rever- sal of the colostomy because of age, comorbidities and other reasons, and thus remain with permanent stoma [8] . Some surgeons perform a one-stage resection with primary anastomosis, but this approach is associated with a high risk for complications [26] . An Italian study has shown that SEMS placement does not exclude laparoscopic resection as a second step and this approach offers a faster recovery [10] .…”

The Cost-Effectiveness of Colonic Stenting as a Bridge to Curative Surgery in Patients with Acute Left-Sided Malignant Colonic Obstruction: A Canadian Perspective

“…There is a 4% risk of developing an anastomotic leak, which requires another operation to take down the anastomosis and create a temporary colostomy (19,20). After emergency resection, the patient remains in the intensive care unit (ICU) for two days and then another 12 days in the surgical ward (3,21,22).…”

Surgery of Colon Cancer

“…There are two options for one-stage operation: standard colectomy with on-table colonic lavage or subtotal colectomy. The safety of the colonic lavage technique has been well documented, with a mortality rate of less than 10% and an anastomotic leakage rate of 5% (79)(80)(81)(82). A prospective, randomized trial comparing subtotal colectomy with standard colectomy with colonic lavage showed that the two techniques have similar rates of complication and mortality (83).…”