[Obstruction caused by colorectal cancer. Surgical development].
The evolution of surgery for obstructed colon started at the turn of the century, and was guided by 3 main therapeutic principles: decompression (colostomy or internal derivation); tumour resection; reestablishment of function. These objectives were attained with various solutions and can be summarized in 3 approaches: the 3 stage operation, the 2 stage operation with initial resection of the tumour and finally the colonic resection with immediate reestablishment of function. The analysis and comparison of our personnel experience (n = 655), and the review of the literature lead us to the following conclusions: 1) the 3 stage operation, with a global mortality in our series of 27.6%, has been abandoned and is rarely dependable today; 2) the primary resection of the tumour, which should be an important objective, reduces mortality (18.8% in our experience); 3) of the methods including the primary resection of the tumour, those with immediate reconstruction of the digestive integrity and sub-total colectomy should be favoured, using the ileon as the proximal limb of the anastomosis (8.5% mortality in our series).
Pereira
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CA
D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods; D003108:Colonic Diseases / Q000209:etiology* / Q000601:surgery; D015179:Colorectal Neoplasms / Q000150:complications* / Q000601:surgery; D003125:Colostomy; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000601:surgery; D008297:Male
Les obstructions colo-rectales par cancer. Evolution de la chirurgie.