Surgery for Obstructed Colorectal Malignancy in an Asian Population: Predictors of Morbidity and Comparison Between Left- and Right-Sided Cancers

Abstract

In an Asian population, surgery in patients with acute colorectal malignant obstruction is associated with significant morbidity and mortality rates. Though left-sided malignant obstruction occurs more frequently and is associated with a higher incidence of stoma creation, primary resection and anastomosis is a safe option in selected patients.

Is Total-subtotal Colectomy and Primary Anastomosis Good Treatment Alternatives in Malignant Obstructive Lesions of the Left Colon?

“…[7] Intraluminal fecal loading and the difference between the proximal and distal colon diameters renders difficulty in terms of anastomosis technique in patients treated by resection and primary anastomosis. [26,27] An increased incidence of anastomosis leak, which is the most significant disadvantage, has currently been reported within 1-7% in several studies, and the mortality rate has been reported to be 2-9%. [25] In our clinic, we prefer to perform a colostomy in patients with resection and anastomosis in order to lower the morbidity and mortality rates related with anastomosis leakage.…”

“…Many studies comparing two-step procedures requiring colostomy and resection plus primary anastomosis have demonstrated that length of hospital stay was longer, morbidity was higher, and survival was lower in the two-step procedures. [27] Another treatment alternative in obstructive lesions of the left colon is total-subtotal colectomy plus anastomosis between the ileum and rectum or sigmoid colon. The tumor can be resected in a single session and stoma complications can be avoided.…”

“…In some studies, it has been shown that this surgical procedure has an advantage in treating synchronous tumors (11%) in a single step. [26,27] In this way, the anastomosis between the ileum and rectum/sigmoid colon can be performed with a good technique without contaminating the abdominal cavity. In emergent surgeries, the leakage risk was higher in colo-colonic anastomosis than in ileocolic anastomosis.…”

“…In emergent surgeries, the leakage risk was higher in colo-colonic anastomosis than in ileocolic anastomosis. [27,28] The longer operation time, postoperative diarrhea and incontinence in elderly patients are the disadvantages of the procedure. [7,27] In most of the patients, the diarrhea resolves spontaneously or with medical treatment in a few months.…”

“…[27,28] The longer operation time, postoperative diarrhea and incontinence in elderly patients are the disadvantages of the procedure. [7,27] In most of the patients, the diarrhea resolves spontaneously or with medical treatment in a few months. [26,27] Reported complication rates associated with this technique in several series are from 2-8% for anastomosis leakage, 10-21% for morbidity, and 0-10% for mortality, which are all lower than with multi-step procedure alternatives.…”